Focal therapy for prostate cancer – index lesion treatment vs. hemiablation. A matter of definition

Stabile, Armando; Moschini, Marco; Montorsi, Francesco; Cathelineau, Xavier; Sánchez-Salas, Rafael

doi:10.1590/s1677-5538.ibju.2019.05.02

Cited by 13 publications

(10 citation statements)

References 20 publications

(25 reference statements)

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“…Although, prostate cancer is often multifocal disease, a single index lesion, which is largest and most aggressive clinically significant focus of prostate cancer, drives the disease progression in most cases. [ 30 31 ] The higher positive predictive value of combined use of mpMRI and 68 Ga PSMA PET CT in series, along with higher spatial resolution of MRI, may be useful in selecting index lesion for the focal therapies. However, the cost and availability of PET CT may limit its wider usage.…”

Section: Discussionmentioning

confidence: 99%

Multiparametric magnetic resonance imaging, ⁶⁸Ga prostate-specific membrane antigen positron emission tomography–Computed tomography, and respective quantitative parameters in detection and localization of clinically significant prostate cancer in intermediate- and high-risk group patients: An Indian demographic study

et al. 2021

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Objectives: The objective of this study was to evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and 68 Ga prostate-specific membrane antigen positron emission tomography–computed tomography (PSMA PET-CT) and respective quantitative parameters (K trans – influx rate contrast, K ep – efflux rate constant, ADC – apparent diffusion coefficient, and SUVmax ratio – prostate SUVmax to background SUVmax ratio) in detection and localization of clinically significant prostate cancer (CSPCa) in D’Amico intermediate- and high-risk group patients (prostate-specific antigen [PSA] >10 ng/ml). Methodology: The study included thirty-three consecutive adult men with serum prostate specific antigen >10ng/ml, and systematic 12 core prostate biopsy proven prostate cancer. All the 33 patients, were evaluated with mpMRI, and 68 Ga PSMA PET-CT. The biopsy specimens and imaging were evaluated for 12 sectors per prostate by a predetermined scheme. Results: MpMRI Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score ≥3 showed higher sensitivity than 68 Ga PSMA PET-CT (96.3% vs. 82.4%), with similar specificity (54.5% vs. 54.5%) ( n = 33 patients, 396 sectors). Combined use of MRI and 68 Ga PSMA PET-CT in parallel increased sensitivity (99.5%) and NPV (98.7%) for detection of CSPCa and combined use of MRI and 68 Ga PSMA PET-CT in series increased specificity (71.8%) and PPV (71.5%) ( n = 33 patients, 396 sectors). ADC showed a strong negative correlation with Gleason score (r = −0.77), and the highest discriminative ability for detection and localization of CSPCa (area under curve [AUC]: 0.91), followed by K trans ( r = 0.74; AUC: 0.89), PI-RADS (0.73; 0.86), SUVmax ratio (0.49; 0.74), and K ep (0.24; 0.66). Conclusion: MpMRI PI-RADS v2 score and 68 Ga PSMA PET-CT (individually as well as in combination) are reliable tool for detection and localization of CSPCa. Quantitative MRI and 68 Ga PSMA PET-CT parameters have potential to predict Gleason score and detect CSPCa.

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Section: Discussionmentioning

confidence: 99%

Multiparametric magnetic resonance imaging, ⁶⁸Ga prostate-specific membrane antigen positron emission tomography–Computed tomography, and respective quantitative parameters in detection and localization of clinically significant prostate cancer in intermediate- and high-risk group patients: An Indian demographic study

et al. 2021

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“…The ablation template may differ according to the size of the lesion to treat. There are different techniques used for focal ablation including targeted focal ablation, quadrant ablation, hemi-ablation of the prostate gland and 'hockey stick' or extended ablation [20][21][22]. mpMRI of the prostate has become one of the most valuable tools for the detection and subsequent treatment of PCa [23].…”

Section: Discussionmentioning

confidence: 99%

Multiparametric magnetic resonance imaging of the prostate underestimates tumour volume of small visible lesions

et al. 2021

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To assess the relationship between the volume of the index lesion (IL) measured at multiparametric magnetic resonance imaging (mpMRI; MRIvol) and at radical prostatectomy (RPvol), stratifying it according to Prostate Imaging-Reporting and Data System (PI-RADS) score. Patients and MethodsWe identified 332 men with a positive mpMRI (single lesion with PI-RADS ≥3) who underwent systematic plus targeted biopsy and subsequent RP at two tertiary referral centres between 2013 and 2018. All mpMRIs were reviewed by experienced radiologists using PI-RADS scores. The study outcome was to assess the relationship between MRIvol (based on planimetry from MRI sequence best showing tumour) and RPvol (based on tumour involved area of each RP pathology slice). To achieve this endpoint, we performed a multivariable linear regression analysis (LRA) to predict RPvol using PI-RADS, prostate-specific antigen level, prostate volume, age, digital rectal examination, Gleason score at MRI-targeted biopsy, biopsy history and time from mpMRI to RP as covariates. Non-parametric locally estimated scatterplot smoothing (LOESS) function was used to graphically explore the relationship between MRIvol and RPvol, stratifying for PI-RADS score. ResultsOverall, 24%, 49% and 27% of men had visible PI-RADS 3, 4 and 5 lesions at mpMRI. The median (interquartile range [IQR]) MRIvol and RPvol were 0.67 (0.29-1.76) mL and 1.39 (0.58-4.23) mL. At LRA, MRIvol was significantly correlated with a RPvol underestimation (slope: 2.4, 95% confidence interval [CI] 0.1-46.3). The non-parametric LOESS analysis showed a non-linear relationship between MRIvol and RPvol. Significant underestimation was reported across all volumes with the highest differences between MRIvol and RPvol in the low volume range (<2 mL), where RPvol almost doubled MRIvol. A similar effect was observed across all PI-RADS scores subgroups. ConclusionsIn the present study, mpMRI significantly underestimated the exact volume of the IL, especially for small visible lesions, regardless of PI-RADS score. This should be considered when planning tailored focal therapy approaches often delivered to men with smaller prostatic lesions.

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“…Rather than targeting the entire gland, focal therapy concentrates on treating “the index lesion,” which is defined as the dominant tumor visible on MRI. 115 Treating the index lesions helps to attack the most prominent locus of tumor growth, which can disrupt tumor growth, cellular proliferation, and cancer progression. 116 Ideally, focal therapy will avoid the many associated adverse effects of the standard definitive radical treatments for prostate cancer, while still treating the cancer effectively, as it only potentially targets the areas with cancer within the gland.…”

Section: Trus For Focal Therapy Of Prostate Cancermentioning

confidence: 99%

Transrectal Ultrasound in Prostate Cancer: Current Utilization, Integration with mpMRI, HIFU and Other Emerging Applications

Panzone¹,

Byler²,

Bratslavsky³

et al. 2022

CMAR

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Focal therapy for prostate cancer – index lesion treatment vs. hemiablation. A matter of definition

Cited by 13 publications

References 20 publications

Multiparametric magnetic resonance imaging of the prostate underestimates tumour volume of small visible lesions

Transrectal Ultrasound in Prostate Cancer: Current Utilization, Integration with mpMRI, HIFU and Other Emerging Applications

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