Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer

Jaipuria, Jiten; Ahmed, Hashim U.

doi:10.1097/mou.0000000000000976

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…In three cases, systematic biopsies did not yield any new diagnosis of csPCa but resulted in an up-grading of targeted biopsies from ISUP-GG 2 to ISUP-GG 3 in two cases, and to ISUP-GG 5 in one case. We consider these findings important for establishing the management of localized PCa with active surveillance or focal therapy ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of mapping-targeted biopsies on the index lesion in transperineal prostate biopsies

Paesano,

Catalá,

Tcholakian

et al. 2024

Int. braz j urol.

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Purpose: To evaluate the eff ectiveness of mapping-targeted biopsies (MTB) on the index lesion for the detection of clinically significant prostate cancer (csPCa) in transperineal fusion-image prostate biopsies. Materials and Methods:A retrospective analysis was conducted on 309 men with suspected PCa who underwent prostate biopsies at the Creu Blanca reference center in Barcelona, Spain. The Prostate Imaging-Reporting and Data System (PI-RADS v.2.1) of the magnetic resonance images (MRI) were reclassified by an expert radiologist reading of pre-biopsy biparametric MRI used for segmentation of suspected lesions. Transperineal MTB of suspicious lesions and 12-core systematic biopsies were performed using the Artemis™ platform.CsPCa was defined as International Society of Urological Pathology grade group ≥ 2.Results: CsPCa was detected in 192 men (62.1%), with detection rates of 6.3% for PI-RADS 2, 26.8% for PI-RADS 3, 87.3% for PI-RADS 4, and 93.1% for PI-RADS 5. MTB of the index lesion identified 185 csPCa (96.3%). CsPCa was detected solely in systematic biopsies in three cases (1.6%), while an additional four cases (2.1%) were identified only in the second suspected lesion. A predictive model for csPCa detection in MTB of the index lesion was developed, with an AUC of 0.918 (95% CI 0.887-0.950). Conclusions:This model had the potential to avoid 23.3% of prostate biopsies without missing additional csPCa cases. MTB of the index lesion was highly eff ective for identifying csPCa in fusion transperineal prostate biopsies. A developed predictive model successfully reduced the need for almost one quarter of biopsies without missing csPCa cases.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of mapping-targeted biopsies on the index lesion in transperineal prostate biopsies

Paesano,

Catalá,

Tcholakian

et al. 2024

Int. braz j urol.

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“…A substantial body of research has demonstrated that the majority, namely over 80%, of primary prostate cancers exhibit the presence of multiple distinct tumor foci [14]. The presence of multifocality holds the potential to exert a substantial impact on the strategic considerations for focal therapy in this particular patient cohort [15].…”

Section: Introductionmentioning

confidence: 99%

Multifocality in Testicular Cancer: Clinicopathological Correlations and Prognostic Implications

Bumbasirevic,

Petrovic,

Zekovic

et al. 2024

Life

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There are limited data regarding the significance of multifocality in testicular cancer patients. This study evaluated the relationship between multifocality and clinicopathological features determined at the time of radical orchiectomy. The study involved 280 consecutive patients who underwent radical orchiectomy between 2018 and 2023. Multifocality was defined as a distinct tumor focus characterized by a group of malignant cells > 1 mm, clearly differentiated from the primary tumor mass. Uni- and multivariate logistic regression analyses were employed to investigate the association between multifocality and histopathological parameters along with potential risk factors for clinical stages II + III. Multifocality was identified in 44 (15.7%) patients. Significantly smaller primary tumors were observed in subjects with multifocality (20.0 mm vs. 30.0 mm, p = 0.0001), while those exhibiting monofocality presented a markedly elevated rate of tumors exceeding 4 cm (40.3% vs. 18.2%, p = 0.005). Furthermore, multifocality was associated with a significantly higher rate of primary tumors < 2 cm (52.3% vs. 29.2%, p = 0.003). Univariate logistic regression analysis revealed a substantial decrease in the likelihood of multifocality occurrence in seminoma patients with tumors > 4 cm (OR = 0.38, p = 0.017). Meanwhile, in multivariate logistic regression, multifocality did not emerge as a significant risk factor for clinical stages II + III in either seminoma (p = 0.381) or non-seminoma (p = 0.672) cases. Our study suggests that multifocality holds no substantial prognostic relevance for clinically advanced disease in testicular cancer patients. The findings indicate that multifocality is associated with smaller primary tumors, particularly those measuring less than 2 cm.

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“…FT success largely revolves around appropriate patient selection and is paramount for optimal success. The ideal case for focal therapy should be an MRI visible significant lesion (PIRADS score ≥3), with a positive targeted biopsy for significant cancer (Gleason grade group 2–3), and insignificant or absent disease in the nontarget random biopsy areas ( 9 ). This could theoretically be applied to multiple areas of interest within the same gland if amenable.…”

Section: Introductionmentioning

confidence: 99%

Narrative review—focal therapy: are we ready to change the prostate cancer treatment paradigm?

Williams¹,

Benjamin²,

Schwartz³

et al. 2023

Ann Transl Med

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Background and Objective: Prostate cancer (PCa) has seen improved detection methods with a subsequent rise in disease prevalence, making novel prostate cancer treatment options an exciting yet controversial topic. Current treatment modalities encompass traditional approaches, namely surgery (radical prostatectomy) and radiation therapy. While heralded as a standard of care, these modalities may come with significant risk profiles, primarily sexual (erectile dysfunction) and urinary incontinence. Advances in technology and imaging, specifically multi-parametric MRI, have afforded great leaps in targeted focal therapy as a primary treatment option for localized PCa. This review identifies and highlights published data for novel and emerging PCa focal therapy (FT) modalities.Methods: Our study identified and reviewed the current literature for relevant investigations related to primary focal therapy (FT) modalities as they apply to the treatment of prostate cancer. After an internal review, relevant studies (published in English, between 2000-April 2022) were included for analysis and summarization.

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Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer

Cited by 6 publications

References 35 publications

The effectiveness of mapping-targeted biopsies on the index lesion in transperineal prostate biopsies

The effectiveness of mapping-targeted biopsies on the index lesion in transperineal prostate biopsies

Multifocality in Testicular Cancer: Clinicopathological Correlations and Prognostic Implications

Narrative review—focal therapy: are we ready to change the prostate cancer treatment paradigm?

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