Background and objective: Minimally invasive interventions, including irreversible electroporation (IRE), cryoablation, and high-intensity focused ultrasound (HIFU), offer promising alternatives for the treatment of low- and intermediate-risk prostate cancer. We aimed to evaluate the oncological efficacy and safety of these treatments. Methods: A systematic search of MEDLINE, Central, and EMBASE was conducted up to 5 January 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Recurrence, complication, survival, biochemical, and retreatment rates were evaluated, with risk of bias assessed using the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) and Risk of Bias 2 (RoB2) tools. Results: 85 studies met the inclusion criteria, comprising 42 prospective cohort studies, 36 retrospective cohort studies, six registries, and one randomized controlled trial. Whole-gland HIFU showed significantly lower recurrence (15%) and postoperative mean PSA levels (0.68 ng/mL) than focal HIFU (24%, 2.81 ng/mL). Recurrence rates were similar for focal vs. extended IRE (30% vs. 26%) and focal vs. whole-gland cryoablation (18% vs. 13%). In-field and out-of-field recurrence rates were similar across treatment modalities (5–15%). Retreatment rates were low, with 6–7% of patients receiving a second ablation and 2–8% progressing to radical or hormonal therapy. Major complications were consistently rare. One-year biochemical recurrence-free survival (BRFS) exceeded 95%, and five-year BRFS approached 80% for HIFU and cryoablation. Conclusions: Minimally invasive focal and whole-gland therapies are safe and effective for treating low- and intermediate-risk prostate cancer, with high survival and low major complication rates. Notably, whole-gland HIFU achieves superior biochemical control and lower recurrence than focal HIFU, emphasizing the clinical importance of treatment extent.
背景与目的：包括不可逆电穿孔、冷冻消融和高强度聚焦超声在内的微创介入治疗，为低危和中危前列腺癌提供了前景广阔的治疗选择。本研究旨在评估这些治疗的肿瘤学疗效与安全性。方法：根据系统综述和荟萃分析优先报告项目指南，对截至2025年1月5日的MEDLINE、Central和EMBASE数据库进行系统检索。评估指标包括复发率、并发症发生率、生存率、生化指标及再治疗率，并采用非随机干预研究偏倚风险评估工具和偏倚风险评估2.0工具进行偏倚风险评价。结果：共纳入85项符合标准的研究，包括42项前瞻性队列研究、36项回顾性队列研究、6项注册研究和1项随机对照试验。全腺体高强度聚焦超声的复发率（15%）和术后平均前列腺特异性抗原水平（0.68 ng/mL）显著低于局灶性高强度聚焦超声（24%，2.81 ng/mL）。局灶性与扩展性不可逆电穿孔（30% vs. 26%）、局灶性与全腺体冷冻消融（18% vs. 13%）的复发率相近。各治疗方式的靶区内与靶区外复发率基本一致（5-15%）。再治疗率较低，其中6-7%患者接受二次消融，2-8%进展至根治性或激素治疗。主要并发症发生率始终维持在较低水平。高强度聚焦超声和冷冻消融的一年无生化复发生存率超过95%，五年无生化复发生存率接近80%。结论：微创局灶性与全腺体疗法治疗低危和中危前列腺癌安全有效，具有高生存率和低主要并发症发生率的特点。值得注意的是，全腺体高强度聚焦超声较局灶性治疗能实现更优的生化控制及更低复发率，这凸显了治疗范围在临床决策中的重要性。
肿瘤(癌症)患者之家