前列腺癌局灶治疗的国际进展与复旦经验

Global advances in focal therapy for prostate cancer and the Fudan experience

摘要

局限性前列腺癌治疗需兼顾肿瘤控制与功能保护。局灶治疗（FT）作为介于根治性治疗与主动监测之间的新策略，依托多参数核磁共振成像（MRI）、前列腺特异性膜抗原（PSMA）精准影像和靶向活检实现精准消融。冷冻消融、高强度聚焦超声、非可逆电穿孔及血管靶向光动力治疗等技术在中短期随访中显示出良好的功能学优势，但其长期疗效及适应证仍有待明确。本文主要总结前列腺癌局灶治疗领域近期的国际进展，并介绍复旦大学附属肿瘤医院泌尿外科多学科团队围绕不可逆电穿孔（IRE）全过程构建的“五维管理体系”，为FT的规范化与个体化应用提供参考。

Abstract

The management of localized prostate cancer requires a balance between oncological control and functional preservation. Focal therapy，as an emerging strategy between radical treatment and active surveillance，enables precise tumor ablation based on multiparametric magnetic resonance imaging，prostate-specific membrane antigen（PSMA）-guided imaging and targeted biopsy. Techniques including cryotherapy，high-intensity focused ultrasound，irreversible electroporation，and vascular-targeted photodynamic therapy have demonstrated favorable functional outcomes in short- to mid-term follow-up. However，their long-term efficacy and optimal indications remain to be verified. This article summarizes recent international advances in focal therapy for prostate cancer and introduces the“Penta-Managing System” developed by the multidisciplinary urology team at Fudan University Shanghai Cancer Center based on the full-process application of irreversible electroporation，providing insights for the standardized and individualized use of focal therapy.

关键词

前列腺癌 / 局灶治疗 / 不可逆电穿孔 / 功能保护 / 精准医学

Key words

prostate cancer / focal therapy / irreversible electroporation / functional preservation / precision medicine

参考文献

[1] HAMDY FC， DONOVAN JL， LANE JA， et al. Fifteen-year outcomes after monitoring，surgery，or radiotherapy for prostate cancer[J]. N Engl J Med， 2023，388（17）： 1547-1558.

[2] GHOREIFI A， GOMELLA L， HU JC， et al. Identifying the best candidate for focal therapy：a comprehensive review[J]. Prostate Cancer Prostatic Dis， 2025，28（3）： 684-692.

[3] CORNFORD P， VAN DEN BERGH RCN， BRIERS E， et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer-2024 update. Part Ⅰ：screening，diagnosis，and local treatment with curative intent[J]. Eur Urol， 2024，86（2）： 148-163.

[4] SCHAEFFER EM， SRINIVAS S， ADRA N， et al. NCCN Guidelines© Insights：prostate cancer，version 3.2024：featured updates to the NCCN guidelines[J]. J Natl Compr Canc Netw， 2024，22（3）： 140-150.

[5] 上海市医学会泌尿外科专科分会肿瘤学组， 长三角泌尿专科联盟前列腺肿瘤协作组. 前列腺癌不可逆电穿孔消融局灶治疗专家共识[J]. 上海医学， 2024，47（8）： 457-461.

[6] DONALDSON IA， ALONZI R， BARRATT D， et al. Focal therapy：patients，interventions，and outcomes-a report from a consensus meeting[J]. Eur Urol， 2015，67（4）： 771-777.

[7] TAN YG， LAW YM， NGO NT， et al. Patient-reported functional outcomes and oncological control after primary focal cryotherapy for clinically significant prostate cancer：a phase Ⅱ mandatory biopsy-monitored study[J]. Prostate， 2023，83（8）： 781-791.

[8] PLOUSSARD G， COLOBY P， CHEVALLIER T， et al. Whole-gland or subtotal high-intensity focused ultrasound versus radical prostatectomy：the prospective，noninferiority，nonrandomized HIFI trial[J]. Eur Urol， 2025，87（5）： 526-533.

[9] GEORGE AK， MIOCINOVIC R， PATEL AR， et al. Irreversible electroporation for prostate tissue ablation in patients with intermediate-risk prostate cancer：results from the PRESERVE trial[J]. Eur Urol， 2026，89（1）： 57-68.

[10] AZZOUZI AR， VINCENDEAU S， BARRET E， et al. Padeliporfin vascular-targeted photodynamic therapy versus active surveillance in men with low-risk prostate cancer（CLIN1001 PCM301）：an open-label，phase 3，randomised controlled trial[J]. Lancet Oncol， 2017，18（2）： 181-191.

[11] NICOLETTI R， ALBERTI A， CASTELLANI D， et al. Functional outcomes and safety of focal therapy for prostate cancer：a systematic review on results and patient-reported outcome measures（PROMs）[J]. Prostate Cancer Prostatic Dis， 2024，27（4）： 614-622.

[12] LANTZ A， NORDLUND P， FALAGARIO U， et al. Prostate cancer IRE study（PRIS）：a randomized controlled trial comparing focal therapy to radical treatment in localized prostate cancer[J]. Eur Urol Open Sci， 2023，51： 89-94.

[13] BAUST JG， GAGE AA， BJERKLUND JOHANSEN TE， et al. Mechanisms of cryoablation：clinical consequences on malignant tumors[J]. Cryobiology， 2014，68（ 1）： 1-11.

[14] 万方宁， 戴波， 叶碧然， 等. 前列腺癌冷冻治疗的远期疗效及预测因素[J]. 中华泌尿外科杂志， 2024，45（6）： 451-455.

[15] CROUZET S， ROUVIÈRE O， LAFOND C， et al. Focal high-intensity focused ultrasound（HIFU）[M]//BARRET E，DURAND M. Technical aspects of focal therapy in localized prostate cancer. Paris；Springer Paris. 2015： 137-151.

[16] MORGANS AK， DALE W， BRIGANTI A. Screening and treating prostate cancer in the older patient：decision making across the clinical spectrum[J]. Am Soc Clin Oncol Educ Book， 2017，37： 370-381.

[17] PETTERSSON A， ROBINSON D， GARMO H， et al. Age at diagnosis and prostate cancer treatment and prognosis：a population-based cohort study[J]. Ann Oncol， 2018，29（2）： 377-385.

[18] ROSTA G， TURBA S， MUN DH， et al. Focaltherapy using high-intensity focused ultrasound for low- and intermediate-risk prostate cancer：results from a prospective，multicenter feasibility trial[J]. Cancers， 2025，17（21）： 3429.

[19] LIGHT A， PETERS M， ARYA M， et al. Salvage focal therapy vs radical prostatectomy for localized radiorecurrent prostate cancer[J]. JAMA Oncol， 2026： e256448.

[20] KIEŁBIK A， SZLASA W， SACZKO J， et al. Electroporation-based treatments in urology[J]. Cancers（Basel）， 2020，12（8）.

[21] SCHOELLNAST H， MONETTE S， EZELL PC， et al. The delayed effects of irreversible electroporation ablation on nerves[J]. Eur Radiol， 2013，23（2）： 375-380.

[22] DURAZO-RUIZ FO， ROLDÁN-TESTILLANO R， RODRIGUEZ-SANCHEZ L， et al. Irreversible electroporation in focal therapy for prostate cancer：current status and future directions[J]. Prostate Int， 2026，14（ 1）： 1-9.

[23] OSUCHOWSKI M， BARTUSIK-AEBISHER D， OSUCHOWSKI F， et al. Photodynamic therapy for prostate cancer-a narrative review[J]. Photodiagn Photodyn Ther， 2021，33： 102158.

[24] FAINBERG JS， VJCKRS A， FANTANZA N， et al. 48 month follow up of results of the pcm-204 phase 2B trial of partial-gland ablation for men with intermediate-risk prostate cancer with padeliporfin（WST11 or tookad）vascular-targeted photodynamic therapy[Z]. J Urol， 2025： e716.

[25] CLAES P， AHMADI BIDAKHVIDI N， GIESEN A， et al. PSMA PET/CT and PET/MRI in primary staging of prostate cancer and its effect on patient management[J]. Clin Transl Imaging， 2024，12（1）： 31-54.

[26] MEYER T， CASTELEIN J， SCHATTENFROH J， et al. Magnetic resonance elastography in a nutshell：tomographic imaging of soft tissue viscoelasticity for detecting and staging disease with a focus on inflammation[J]. Prog Nucl Magn Reson Spectrosc， 2024，144-145： 1-14.