Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Sfoungaristos, Stavros; Perimenis, Petros

doi:10.5489/cuaj.268

Cited by 5 publications

(13 citation statements)

References 27 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 In our report, a positive biopsy at the apex was a predictor of contralateral disease. In fact, the apex represents a much smaller proportion of the gland than the mid and base regions.…”

Section: Discussionsupporting

confidence: 49%

See 1 more Smart Citation

Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

Bienz

Hueber²,

Trudeau³

et al. 2015

CUAJ

View full text Add to dashboard Cite

Introduction:We assessed the incidence of contralateral prostate cancer (cPCa), contralateral EPE (cEPE) and contralateral positive surgical margins (cPSM) in patients diagnosed preoperatively with unilateral prostate cancer and evaluated risk factors predictive of contralateral disease extension. Methods: The occurrence of cPCa, cEPE and cPSM and the sidespecific nerve-sparing technique performed were collected postoperatively from 327 men diagnosed with unilateral prostate cancer at biopsy. Parameters, such as the localization, proportion, and percentage of cancer in positive cores, were prospectively collected. Results: Overall, 50.5% of patients had bilateral disease, and were at higher risk when associated with a positive biopsy core at the apex (p = 0.016). The overall incidence of ipsilateral EPE and cEPE were 21.4% and 3.4%, respectively (p < 0.001). Compared to cPCa, ipsilateral disease was at an almost 4-fold higher risk of extending out of the prostate (p < 0.001). None of the criteria tested were identified as useful predictors for cEPE. The low incidence of cEPE in our cohort could limit our ability to detect significance. The overall incidence of ipsilateral PSM and cPSM were 15.3% and 5.8%, respectively (p < 0.001). More aggressive nerve-sparing was not associated with a higher incidence of PSM. Prostate sides selected for more aggressive nerve-sparing were associated with younger patients (p < 0.001), a smaller prostate (p = 0.006), and a lower percentage of cancer in biopsy material (p = 0.008). Conclusion: Although the risk of cPCa is high in patients diagnosed with unilateral prostate cancer at biopsy, the risk of cEPE and cPSM is low, yet not insignificant. Contralateral aggressive nervesparing should be used with caution and should not compromise oncological outcome.

show abstract

Section: Discussionsupporting

confidence: 49%

“…Few studies have focused on the reliability of unilaterally positive biopsies to adequately predict the presence of less invasive disease to the contralateral side. [8][9][10] On the basis of these considerations, we assessed the incidence of bilateral disease, contralateral EPE (cEPE), and contralateral positive surgical …”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

Bienz

Hueber²,

Trudeau³

et al. 2015

CUAJ

View full text Add to dashboard Cite

show abstract

“…[11][12][13][14][15][16][17][18] Two of these studies reported on the rate of bilateral csCaP on WMP (33% and 50%, respectively) in patients with only unilateral disease on TRUS biopsy alone. [11][12][13][14][15][16][17][18] Two of these studies reported on the rate of bilateral csCaP on WMP (33% and 50%, respectively) in patients with only unilateral disease on TRUS biopsy alone.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17] Although there is strong clinical evidence that prostate imaging with mpMRI and targeted biopsy improves csCaP detection on the patient level, [18][19][20][21][22][23] to our knowledge the detection sensitivity for mpMRI for individual CaP foci remains moderate, particularly in smaller, nonindex, multifocal lesions. Appropriate candidates for hemiablation have csCaP limited to 1 prostate lobe.…”

Section: Introductionmentioning

confidence: 99%

Do contemporary imaging and biopsy techniques reliably identify unilateral prostate cancer? Implications for hemiablation patient selection

Johnson

Yang

Kwan

et al. 2019

Cancer

View full text Add to dashboard Cite

BACKGROUND: Hemiablation is a less morbid treatment alternative for appropriately selected patients with unilateral prostate cancer (PCa). However, to the authors' knowledge, traditional diagnostic techniques inadequately identify appropriate candidates. In the current study, the authors quantified the accuracy for identifying hemiablation candidates using contemporary diagnostic techniques, including multiparametric magnetic resonance imaging (mpMRI) and MRI-fusion with complete systematic template biopsy. METHODS: A retrospective analysis of patients undergoing MRI and MRI-fusion prostate biopsy, including full systematic template biopsy, prior to radical prostatectomy in a single tertiary academic institution between June 2010 and February 2018 was performed. Hemiablation candidates had unilateral intermediate-risk PCa (Gleason score [GS] of 3+4 or 4+3, clinical T classification ≤T2, and prostate-specific antigen level <20 ng/dL) on MRI-fusion biopsy and 2) no contralateral highly or very highly suspicious Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) MRI lesions. Hemiablation candidates were inappropriately selected if pathologists identified contralateral GS ≥3+4 or high-risk ipsilateral PCa on prostatectomy. The authors tested a range of hemiablation inclusion criteria and performed multivariable analysis of preoperative predictors of undetected contralateral disease. RESULTS: Of 665 patients, 92 met primary hemiablation criteria. Of these 92 patients, 44 (48%) were incorrectly identified due to ipsilateral GS ≥3+4 tumors crossing the midline (21 patients), undetected distinct contralateral GS ≥3+4 tumors (20 patients), and/ or ipsilateral high-risk PCa (3 patients) on prostatectomy. The rate of undetected contralateral disease ranged from 41% to 48% depending on inclusion criteria. On multivariable analysis, men with anterior index tumors were found to be 2.4 times more likely to harbor undetected contralateral GS ≥3+4 PCa compared with men with posterior lesions (P < .05). CONCLUSIONS: Clinicians and patients must weigh the risk of inadequate oncologic treatment against the functional benefits of hemiablation. Further investigation into methods for improving patient selection for hemiablation is necessary. Cancer 2019;125:2955-2964.

show abstract

“…However, cases with significant PCa were not listed and, like Sinnott et al, cases with Gleason ≥8 on PB were included. Sfoungaristos et al [20] analysed 161 RP for unilateral PCa in a series of at least sextant biopsy, with unilateral disease at final RP in 28% but, in this case, neither significant PCa nor the IL were analysed. In summary, we consider that TRUS-guided random 12-core prostate biopsy fails to detect the presence of significant PCa foci or the IL itself.…”

Section: Discussionmentioning

confidence: 99%

Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy

Fumadó¹,

Rosell²,

Juanpere³

et al. 2015

Urol Int

View full text Add to dashboard Cite

Introduction: To determine whether unilateral prostate cancer diagnosed at 12-core prostate biopsy harbours relevant prostate cancer foci in contralateral lobe in cases eligible for hemiablative focal therapy. Material and Methods: We analysed 112 radical prostatectomies of unilateral Gleason 6/7 prostate cancer based on prostate biopsy information. The presence of significant prostate cancer foci and/or the index lesion in the contralateral lobe is described. A subanalysis is performed in cases of Gleason score 6 and in cases of very-low-risk prostate cancer. Results: Contralateral prostate cancer was present in 69.6% of cases, fulfilling significant prostate cancer criteria in 33% and being the index lesion in 32%. No significant differences were found when analysing the Gleason 6 group (73% contralateral prostate cancer, 34% significant prostate cancer and 35% index lesion) or the very-low-risk prostate cancer group (80% contralateral prostate cancer, 29% significant prostate cancer and 45% index lesion). Conclusions: The assumption of unilateral prostate cancer based on 12-core template prostate biopsy information is unreliable. In about one third of the cases, there will be focus of significant prostate cancer or the index lesion in the contralateral lobe. This information should be taken into account when hemiablative focal therapies are considered.

show abstract

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Cited by 5 publications

References 27 publications

Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

Do contemporary imaging and biopsy techniques reliably identify unilateral prostate cancer? Implications for hemiablation patient selection

Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy

Contact Info

Product

Resources

About