Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer

Mouraviev, Vladimir; Mayes, Janice M.; Sun, Leon; Madden, John F.; Moul, Judd W.; Polascik, Thomas J.

doi:10.1002/cncr.22858

Cited by 126 publications

(70 citation statements)

References 14 publications

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“…23 Out of 261 men with low-risk prostate cancer, defined as clinical stage T1c or T2a, PSA <10 ng/mL, Gleason score ≤6 and only 1 or 2 ipsilateral positive cores on at least sextant biopsy, only 93 (35.1%) had unilateral disease following examination of radical prostatectomy specimens. Coming from the opposite perspective, the authors of another analysis of 1184 radical prostatectomy specimens have reported that 1 out of 5 patients had unilateral, small volume prostate cancer that could be treated with FT. 5 Our analysis revealed that only 45 (28%) out of 161 studied patients with preoperative unilateral prostate cancer, based on biopsy findings, had unilateral disease after radical prostatectomy specimens evaluation. These results confirm that, by using current biopsy schemes, only a small percentage of patients can be correctly identified with unilateral prostate cancer; other preoperative parameters are mandatory for better patients' selection.…”

Section: Discussionmentioning

confidence: 78%

“…Even though prostate cancer is known as a multifocal disease, contemporary studies report an increase in frequency of cancer unifocality from 13% to 38% and unilaterality from 19% to 63%. [3][4][5] Focal therapy has gained a place in the group of potential prostate cancer treatment modalities and several studies are working on the efficacy and reliability of this therapeutic option. Focal therapy may provide sufficient oncological results and minimize postoperative morbidity, although long-term cancer specific survival data are missing.…”

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confidence: 99%

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

Sfoungaristos

Perimenis

2013

CUAJ

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E82Cite as: Can Urol Assoc J 2013;7:E82-E87. http://dx.doi.org/10.5489/cuaj.268. Epub 2011 November 2. AbstractBackground: Focal hemiablative therapy for prostate cancer is a new treatment alternative. Unilateral and unifocal disease are its main limitations. The aim of this study was to identify the epidemiological, clinical and pathological parameters that may predict unilateral disease in patients diagnosed with prostate cancer. Methods:We performed a retrospective analysis of patients at our institution between January 2005 and January 2011. Only patients with unilateral disease in prostate biopsy were part of the study. The analysis included age, preoperative prostate-specific antigen (PSA) and its density, prostate volume, biopsy first and second Gleason pattern and Gleason summary, number of biopsy cores, percentage of cancer in biopsy material and the presence of highgrade prostatic intraepithelial neoplasia. Their role as potential predictors was evaluated by univariate and multivariate analysis. Results: A total of 161 patients had unilateral disease after prostate biopsy. A significant correlation was found between prostate volume, PSA density and percentage of cancer in biopsy material and the presence of unilateral disease in the surgical specimen. These are the same factors significant in the univariate analysis. The results of the multivariate analysis demonstrated that PSA density (p = 0.015) and percentage of cancer in biopsy material (p = 0.028) are the most significant predictors. Interpretation: Our results demonstrate that PSA density and the percentage of cancer in biopsy cores are significant predictors for prostate cancer unilaterality and should be considered for the selection of hemiablative focal therapy candidates.

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Section: Discussionmentioning

confidence: 78%

mentioning

confidence: 99%

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

Sfoungaristos

Perimenis

2013

CUAJ

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“…Recent studies have suggested that only a very small minority of men undergoing radical prostatectomy have pathologically unilateral disease with low risk features that may be amenable to hemiablation of the prostate. 8,23 However, neither of these groups evaluated the proportion of patients with bilateral disease with clinically insignificant tumour foci (o0.5 cm 3 tumour volume, Gleason score p6) on the side contralateral to the index lesion. Role of prostate cancer focality in focal therapy M Karavitakis et al…”

Section: Discussionmentioning

confidence: 99%

“…3 The principal theoretical objection to focal prostate therapy includes the multifocal nature of PCa. However, recent histological studies within the PSAscreening era from the United States have shown that in men undergoing radical prostatectomy, 10-40% have unilateral disease [4][5][6][7][8] and 10-44% have unifocal tumours. [9][10][11][12] These data raise the possibility that halfgland treatment (hemiablation) or focal ablation of tumour foci alone might be possible for between 10% and up to 50% of patients who would currently receive whole-gland treatment; on average, about one-third of men would be suitable.…”

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

120

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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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“…Age, PSA, pathological Gleason score, lymph node status, seminal vesicle invasion, extracapsular extension, positive surgical margin status, year of surgery, race, adjuvant XRT, percent tumor involvement in the RP specimen (measured as described previously 5 ) and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. As PSA and prostate weight had a non-normal distribution and a nonlinear effect of these variables was expected, these variables were transformed to the natural logarithm before analysis.…”

Section: Discussionmentioning

confidence: 99%

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

Schroeck

Sun

Freedland

et al. 2008

Prostate Cancer Prostatic Dis

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We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. BCR was defined as a PSA of 0.2 ng ml À1 or higher at least 30 days after surgery. A nomogram was developed from the Cox model. Predictive accuracy was obtained by calculating bias-corrected Harrell's c and by bootstrap calibration. In multivariate analysis, PSA (hazard ratio 1.39 (95% confidence interval 1.29-1.51)), ECE (1.22 (1.04-1.44)), pG score (1.38 (1.14-1.68), 2.23 (1.76-2.84), 2.69 (2.12-3.40) for pG 3 þ 4, 4 þ 3, 47, respectively), SVI (1.72 (1.40-2.12)), PSM (2.05 (1.73-2.42)), year of surgery (0.65 (0.54-0.77)), African-American race (1.37 (1.13-1.66)), adjuvant ) and prostate weight (0.83 (0.76-0.92)) were identified as independent predictors of BCR (Pp0.018 for all factors). Predictive accuracy of the nomogram was 0.75. Race and prostate weight were independent predictors for BCR after RP. By incorporating these variables, we developed a nomogram, which provides a highly accurate means for estimating risk of BCR after RP.

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Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer

Cited by 126 publications

References 14 publications

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

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

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

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

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