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Tytuł pozycji:

Oncological and Quality-of-life Outcomes Following Focal Irreversible Electroporation as Primary Treatment for Localised Prostate Cancer: A Biopsy-monitored Prospective Cohort.

Tytuł :
Oncological and Quality-of-life Outcomes Following Focal Irreversible Electroporation as Primary Treatment for Localised Prostate Cancer: A Biopsy-monitored Prospective Cohort.
Autorzy :
Blazevski A; St. Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; St Vincent's Clinical School, UNSW, Sydney, Australia. Electronic address: .
Scheltema MJ; St. Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, Amsterdam, The Netherlands.
Yuen B; St. Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
Masand N; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; St Vincent's Clinical School, UNSW, Sydney, Australia.
Nguyen TV; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; St Vincent's Clinical School, UNSW, Sydney, Australia; School of Biomedical Engineering, University of Technology, Sydney, NSW, Australia.
Delprado W; Douglas Hanly Moir Pathology, Macquarie Park, NSW, Australia.
Shnier R; I-MED Radiology, Sydney, NSW, Australia.
Haynes AM; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
Cusick T; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
Thompson J; St. Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; St Vincent's Clinical School, UNSW, Sydney, Australia.
Stricker P; St. Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; St Vincent's Clinical School, UNSW, Sydney, Australia.
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Źródło :
European urology oncology [Eur Urol Oncol] 2020 Jun; Vol. 3 (3), pp. 283-290. Date of Electronic Publication: 2019 May 16.
Typ publikacji :
Journal Article; Research Support, Non-U.S. Gov't
Język :
English
Imprint Name(s) :
Original Publication: [Amsterdam] : Elsevier B.V., [2018]-
Contributed Indexing :
Keywords: Focal therapy*; Irreversible electroporation*; Multiparametric magnetic resonance imaging*; Nanoknife*; Prostate cancer*
Entry Date(s) :
Date Created: 20190520 Latest Revision: 20201118
Update Code :
20201218
DOI :
10.1016/j.euo.2019.04.008
PMID :
31103721
Czasopismo naukowe
Background: Focal irreversible electroporation (IRE) can be used to treat men with localised prostate cancer (PCa) with reduced impact on quality of life (QoL).
Objective: To assess oncological and functional outcomes.
Design, Setting, and Participants: To report on a prospective database of patients undergoing primary IRE between February 2013 and August 2018. A minimum of 12-mo follow-up was available for 123 patients. Median follow-up was 36 mo (interquartile range [IQR] 24-52 mo). A total of 112 (91%) patients had National Comprehensive Cancer Network intermediate risk and 11 (9%) had low risk. A total of 12 (9.8%) had International Society of Urological Pathology (ISUP) grade 1, 88 (71.5%) had ISUP 2, and 23 (18.7%) had ISUP 3.
Intervention: Focal IRE ablation of PCa lesions.
Outcome Measurements and Statistical Analysis: Follow-up involved serial prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and transperineal template mapping biopsy (TTMB) at 12 mo. Failure-free survival (FFS) was defined as progression to whole-gland or systemic treatment or metastasis/death. Functional outcomes were assessed.
Results and Limitations: Median age was 68yr (IQR 62-73yr). Median preoperative PSA was 5.7ng/ml (IQR 3.8-8.0ng/ml). On post-treatment TTMB, in-field recurrence was present in 2.7-9.8% of patients. FFS at 3yr was 96.75%, metastasis-free survival 99%, and overall survival 100%. A total of 18 patients required salvage treatment (12 had repeat IRE; six had whole-gland treatment). The negative predictive value of mpMRI was 94% and sensitivity 40% for detecting in-field residual disease 6 mo after treatment. Among patients who returned questionnaires, 80/81 (98.8%) remained pad free and 40/53 (76%) had no change in erectile function.
Conclusions: Focal IRE in select patients with localised clinically significant PCa has satisfactory short-term oncological outcomes with a minimal impact on patient QoL.
Patient Summary: In this study, 123 patients underwent focal therapy using irreversible electroporation. Follow-up biopsy was clear of residual disease in 90.2-97.3% of patients. Of patients, 96.75% avoided whole gland treatment at 3yr.
(Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)
Comment in: J Urol. 2020 Feb;203(2):254. (PMID: 31710553)

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