Objective To explore the clinical application value of applying the multi-modal im-aging combined with precise targeted focal cryoablation technology for"super-active surveillance"treatment strategy in localized low-risk prostate cancer.Methods The clinical data of 7 patients with localized low-risk prostate cancer who underwent super active monitoring in our hospital from October 2018 to December 2020 were analyzed retrospectively.The median age was 65(59-78)years,and the median PSA before treatment was 8.11(5.02-9.83)ng/ml.The median prostate volume was 35.78(29.61-40.22)ml,and the median preoperative International Prostate Symptom Score(IPSS)was 14(9-20).The median QOL score was 1(0-3),and the median maximum urinary flow rate(Qmax)was 10.9(7.2-12.3)ml/s.The median urinary incontinence(ICI-Q-SF)score was 0,and the median preoperative international erectile function questionnaire(IIEF-5)score was 13(0-18).Ten lesions were diagnosed before operation(1 lesion in 4 patients,2 le-sions in 3 patients).Preoperative pathology showed that they were adenocarcinoma(Gleason score 3+3=6),with clinical stage of T2a in 7 patients.All patients underwent preoperative 18F-PAMA PET/MR multimodal nuclear medicine imaging.Preoperative 3-dimensional reconstruction technology combined with intraoperative ultrasound targeted puncture fusion soft-ware was used to complete the planning and marking before cryosurgery,and precise cryoablation was performed during opera-tion.Serum PSA,18F-PSMA PET/MR and MRI were monitored after operation to evaluate the tumor control.IPSS score,QOL score,Qmax,ICI-Q-SF score and IIEF-5 score were used to evaluate the functional recovery.Results There were 10 lesions in 7 patients.All 10 lesions underwent cryoablation.The median operation time was 46 min(34-65)min.All patients were sucesslully removed indwelling of catheter after 2-3 days.The median follow-up time was 24(12-42)months.The post-operative PSA was significantly lower than that before operation.Six patients had no oncological progression.Only 1 patient had oncological progression and underwent focal targeted cryoablation again.The QOL score,ICI-Q-SF score and IIEF-5 score of 7 patients were basically the same as those before operation,and the IPSS score and Qmax of 5 patients were basically the same as those before operation.Conclusions Taking the"super-active surveillance"treatment mode of 18F-PSMA PET/MR multi-modal nuclear medicine imaging technology combined with intraoperative ultrasound real-time fusion to do precision tar-geted cryoablation in the treatment of limited low-risk prostate cancer is a more active clinical strategy for focal treatment based on reasonable risk stratification and combined with patients health status and subjective wills.
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