专家简介：

 

 

Laurence H. Klotz， MD， FRCSC， CM

 

 

2016年，Journal of Urology杂志在前列腺癌领域发表了很多顶级文章，多数涉及MRI在前列腺癌主动监测中的作用，前列腺癌间歇治疗。其中一篇文章显示，如果联合MRI及其他临床指标对患者的监测随访有效，则可减少活检的次数。另一篇文章指出，肿瘤异质性是系统活检为阳性而靶向活检为阴性的原因之一。一项关于雄激素剥夺治疗（ADT）间歇疗法的研究显示，间歇治疗可以降低心血管疾病、骨折及其他治疗并发症。此外，一些关于重点疗法（focal therapy）的研究显示出非常好的治疗效果。

 

Prof. Klotz: A lot of the papers were on either the role of MRI in prostate cancer， active surveillance and intermittent therapy. One paper showed that the number of biopsies could be reduced in patients who were on surveillance on follow-up， if the combination of MRIs and other clinical parameters were favorable. Another paper addressed why systematic biopsies are sometimes positive and targeted biopsies are negative， and some of the errors that account for that， including tumor heterogeneity. There were some studies on focal therapy that show very favorable outcomes. There was a study on intermittent therapy with ADT that showed a reduced rate of cardiovascular disease， fractures， and other complications of treatment using intermittent therapy.

 

 

Klotz教授在采访中指出，Focal Therapy通常意味着应用非侵入性影像学手段治疗部分前列腺（一半或者更少的前列腺）。目前有几种不同的重点疗法类型，包括只针对病灶进行治疗和针对病灶及周围组织治疗，以治疗一半或更多的前列腺，而不是整个前列腺部位。

 

Prof. Klotz: Focal therapy usually means treating part of the prostate (half of the prostate or less) with a non-invasive imaging modality. There are several different types of focal therapy ranging from treating just the lesion， treating the lesion and surrounding tissue， to treating half or more of the prostate， but not the whole prostate.

 

 

Klotz教授认为，虽然Focal Therapy尚存争议，但已有研究显示出较好的治疗结果。其优点是保留了功能，多数接受Focal Therapy的患者很少或没有排尿功能及勃起功能上的长期影响。如果肿瘤已经通过局限治疗治愈，那么就生活质量而言，患者将长期处在一个好的生存状态中。其缺点是遗留了部分未接受治疗的前列腺，可能会在将来出现复发。

 

Prof. Klotz: The advantage is that you preserve functional outcomes. Most patients who have focal therapy have little or no long-term effects on voiding function and erectile function. If the cancer is cured with this limited treatment， the patient is in a better place in terms of quality of life. The disadvantage is leaving untreated parts of the prostate that may develop cancer in the future.

 

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