Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens

Wise, Alphaeus M; Stamey, Thomas A.; McNeal, John E.; Clayton, John L.

doi:10.1016/s0090-4295(02)01728-4

Cited by 339 publications

(214 citation statements)

References 15 publications

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“…Most importantly, the Stanford group elegantly demonstrated that progression was related to the index lesion and not the secondary foci. 13 Our analysis of the histopathological characteristics of the index lesion demonstrates that index lesion ablation may be a possible therapeutic strategy under the umbrella of focal therapy. Indeed, two groups have already commenced prospective trials evaluating the role of ablating the dominant lesion in clinically localized PCa.…”

Section: Discussionmentioning

confidence: 91%

“…Furthermore, it has been suggested that in multifocal disease, the largest cancer focus (index lesion) determines disease progression and secondary lesions do not contribute to clinical outcome. [13][14][15] Therefore, targeting the index lesion alone may be sufficient. 1,16,17 Our objective was to examine the pathological features of clinically localized PCa in a UK series to (1) evaluate cancer focality and (2) determine the relationship between the index lesion and histological features of prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy

Karavitakis

Winkler

Abel

et al. 2010

Prostate Cancer Prostatic Dis

118

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It has been suggested that in multifocal prostate cancer (PCa), focal therapy to the largest (index) lesion is sufficient, because secondary non-index lesions are unlikely to contribute to disease progression. In this study, the role of PCa focality in selecting men for focal therapy was evaluated. A histopathological analysis of the index and non-index lesions of 100 consecutive radical prostatectomy specimens was carried out. Cases that would have been suitable for focal ablation were also evaluated. Tumours were more often multifocal (78%) and bilateral (86%). In total, 270 tumour foci were identified. In multifocal disease, tumour volume, Gleason score and pathological stage were almost invariably defined by the index lesion of the specimen; among the 170 satellite foci, 148 (87%) were o0.5 cm 3 and 169 (99.4%) had Gleason score p6. Using the defined criteria, 51% of men in this series would have been considered suitable for focal ablation of the index lesion. Histological features of poor prognosis in the prostate are associated with the index lesion. There is a high proportion of patients who may be suitable for focal therapy, and clinical trials of index lesion ablation should be considered as part of this therapeutic strategy.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy

Karavitakis

Winkler

Abel

et al. 2010

Prostate Cancer Prostatic Dis

118

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show abstract

“…This would mean that small satellite tumors might be clinically irrelevant and it is the index tumor to be evaluated for the BCR prediction. Wise et al 16 examined the significance of additional estimate of satellite tumor volumes in postoperative BCR prediction in 486 patients. The mean index tumor volume was 4.16 ml and satellite tumor volumes averaged 0.63 ml.…”

Section: Discussionmentioning

confidence: 99%

Maximum tumor diameter: a simple independent predictor for biochemical recurrence after radical prostatectomy

Fukuhara

Kume

Suzuki

et al. 2010

Prostate Cancer Prostatic Dis

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Previous studies have suggested that maximum tumor diameter (MTD) is a predictor of PSA recurrence or biochemical recurrence (BCR) in prostate cancer after radical prostatectomy (RP). The significance of MTD in BCR prediction was evaluated using RP specimens of 364 patients with a BCR of 18% (n ¼ 66) during a mean follow-up of 37.4 months (range: 10-109 months). MTD was defined as the largest diameter of the largest tumor, and its median MTD was 15 mm (range: 0.9-50 mm). MTD was significantly associated with pre-operative PSA levels, pathological T stage, Gleason's score and positive surgical margin. In a univariate analysis, pathological T stage, Gleason's score, positive surgical margin and MTD were associated significantly with the risk of BCR. Patients with 420 mm MTD had a significantly higher risk of BCR than did those with p20 mm MTD (Po0.001). Cox multivariate models indicated that pathological stage, Gleason's score, positive surgical margin and MTD were independent prognostic factors for BCR. MTD would be a useful tool for predicting BCR, as calculation of MTD is a simple and reliable measure.

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“…First, the natural history of the disease seems to be linked to the 'index lesion' in the majority of men, and secondary low grade lesions seem to have an indolent behaviour in most if not all cases (4)(5)(6). Second, our ability to risk stratify men at a regional level within the prostate has significantly increased.…”

Section: Introductionmentioning

confidence: 99%

New and Established Technology in Focal Ablation of the Prostate: A Systematic Review

et al. 2017

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Word Count (text): 4,713Keywords: focal therapy, partial ablation, prostate cancer 2 ABSTRACT Context: focal therapy of prostate cancer has been proposed as an alternative to wholegland treatments.Objective: to summarise the evidence regarding sources of energy employed in focal therapy.Evidence Acquisition: Embase and Medline (PubMed) were searched from 1996 to 31 st October 2015 following the PRISMA statement. Ongoing trials were selected from electronic registries.Evidence Synthesis: thirty-seven articles reporting on 3,230 patients undergoing focal therapy were selected. 13 reported on high intensity focused ultrasound (HIFU), 11 on cryotherapy, three on photodynamic therapy (PDT), four on laser interstitial thermotherapy (LITT), two on brachytherapy, three on irreversible electroporation (IRE), and one on radiofrequency (RFA). HIFU, cryotherapy, PDT and brachytherapy have been assessed in up to stage 2b studies. LITT and IRE have been evaluated in up to stage 2a studies. RFA has been evaluated in one stage 1 study. Median follow-up varied between 4-61 months, and median rate of serious adverse events ranged between 0-10.6%. Pad-free leak-free continence and potency were obtained in 83.3-100% and 81.5-100%, respectively. In series with intentionto-treat, the median rate of significant and insignificant disease at control biopsy varied between 0-13.4% and 5.1-45.9%, respectively. Main limitations are the length of follow-up, the absence of a comparator arm, and study heterogeneity.Conclusion: focal therapy has been evaluated using seven sources of energy in single-arm retrospective and prospective development studies up to stage 2b. Focal therapy seems to 3 have minor impact on quality of life and genito-urinary function. Cancer-control is encouraging, although this needs to be verified in high quality comparative effectiveness studies.Patient summary: seven sources of energy have been employed to selectively ablate discrete areas of prostate cancer. There is high evidence that focal therapy is safe and has low detrimental impact on continence and potency. The oncological outcome has yet to be evaluated against standard of care.

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Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens

Cited by 339 publications

References 15 publications

Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy

Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy

Maximum tumor diameter: a simple independent predictor for biochemical recurrence after radical prostatectomy

New and Established Technology in Focal Ablation of the Prostate: A Systematic Review

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