Prostate Saturation Biopsy in the Reevaluation of Microfocal Prostate Cancer

Boccon-Gibod, L; Longchamps, N. Barry De; Toublanc, M.; Boccon‐Gibod, Liliane; Ravery, Vincent

doi:10.1016/j.juro.2006.04.013

Cited by 61 publications

(10 citation statements)

References 10 publications

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“…SPBx has been proposed as a staging tool for revaluating patients with microfocal PCa [13]. Boccon-Gibod et al [23] reported that in 34 patients submitted to repeat SPBx the presence of multifocal PCa and un-upgrading of GS was true in 70 and 20% of the cases, respectively. Moreover, in 55 patients with microfocal disease who underwent RRP after SPBx we detected a significant cancer in 85% of the cases, with presence of non-OC PCa in 27.3% of them [22].…”

Section: Discussionmentioning

confidence: 99%

Is PCA3 Score Useful in Preoperative Staging of a Single Microfocus of Prostate Cancer Diagnosed at Saturation Biopsy

Pepe

Fraggetta²,

Galia³

et al. 2012

Urol Int

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Objective: To evaluate prostate cancer gene 3 (PCA3) score accuracy in preoperative staging of cases of single microfocus of prostate cancer (PCa; less than 5% with Gleason score ≤6) diagnosed after repeat saturation biopsy (median 30 cores). Methods: From January 2009 to March 2012, 38 patients (median 64 years) with a microfocus of PCa, median PSA of 9.1 ng/ml and T1c clinical stage underwent radical retropubic prostatectomy. PCA3 score (cut-off of 20 vs. 35) was evaluated in predicting insignificant PCa (pIPCa: cancer volume <0.5 ml and Gleason score ≤6) versus organ-confined (OC) versus non-OC PCa. Results: Median PCA3 score results were equal to 10 versus 53 (p < 0.05) versus 108 (p < 0.05) in the presence of pIPCa (13.2%), versus OC (65.8%) versus non-OC PCa (21%), respectively. PCA3 scores were significantly correlated with tumor volume. Conclusions: A PCA3 score cut-off >20 in the presence of a microfocus of PCa is highly predictive of significant PCa (diagnostic accuracy equal to 86.8%) at definitive specimen.

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Section: Discussionmentioning

confidence: 99%

Is PCA3 Score Useful in Preoperative Staging of a Single Microfocus of Prostate Cancer Diagnosed at Saturation Biopsy

Pepe

Fraggetta²,

Galia³

et al. 2012

Urol Int

View full text Add to dashboard Cite

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“…18,[21][22][23][24] The spectrum of prostate biopsy cores taken ranges from 6 to 80þ, yet it is not known how many cores are …”

Section: Patient Selectionmentioning

confidence: 99%

“…sufficient to assure that a clinically significant cancer will not be missed on the untreated side, 21,22,[24][25][26][27] Even a single positive core that is identified in low-risk PCa when obtained with routine transrectal biopsy techniques may not exclude bilateral disease in all instances. Barber and associates 28 investigated the data of 129 men with a single positive PCa core (in a 6-12 core biopsy), with 46 (36%) patients subsequently treated with RP.…”

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confidence: 99%

Contemporary Results of Focal Therapy for Prostate Cancer Using Cryoablation

Mouraviev

Johansen

Polascik

2010

Journal of Endourology

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The concept of focal therapy is rapidly evolving and gaining popularity from both physician and patient perspectives. We review the rationale, candidate selection, and results of the first clinical studies of focal cryoablation for selected patients with low volume and low-to low-moderate-risk features of prostate cancer as an alternative to whole-gland treatment. In spite of improved understanding of the tumor biology of early stage disease, we currently have limited tools to select appropriate patients with low-to low-moderate risk unifocal or unilateral prostate cancer who may be amenable to focal therapy. From a technical point, a number of ablative treatment options for focal therapy are available, with cryoablation having the most clinical experience. Recently, several reports have been published from single and multi-institutional studies that discuss focal therapy as a reasonable balance between cancer control and quality-of-life outcomes. Retrospective pathologic data from large prostatectomy series, however, do not clearly reveal valid and reproducible criteria to select appropriate candidates for focal cryoablation because of the complexity of tumorigenesis in early stage disease. At this time, a more feasible option remains hemiablation of the prostate with reasonable certainty about the absence of clinically significant cancer lesion(s) on the contralateral side of the prostate based on three-dimensional transperineal prostate biopsy mapping studies. Minimally invasive, parenchyma-preserving cryoablation can be considered as a potential feasible option in the treatment armamentarium of early stage, localized prostate cancer in appropriately selected candidates. There is a need to further test this technique in randomized, multicenter clinical trials.

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“…Recently, saturation prostate biopsy (SPBx: 24 or more cores) has been proposed [2] as a staging tool for evaluating patients with microfocal PCa characterized by a single microfocus (5% or less) of Gleason score (GS) 6 cancer on primary biopsy. Boccon-Gibod et al [3] first reported on the clinical use of repeat SPBx in 34 patients with a diagnosis of microfocal PCa on a 10-core biopsy set: SPBx was helpful in distinguishing the 30% of men who probably have minimal disease, on the basis of negative SPBx, from the 70% with multifocal disease (17 points) or grade 4 PCa (7 points)…”

Section: Introductionmentioning

confidence: 99%

Is a Single Focus of Low-Grade Prostate Cancer Diagnosed on Saturation Biopsy Predictive of Clinically Insignificant Cancer?

Pepe¹,

Fraggetta

Galia

et al. 2010

Urol Int

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Objectives: To evaluate the incidence of indolent prostate cancer (PCa; <0.5 ml cancer and Gleason score, GS, ≤6) in men with microfocal PCa diagnosed on saturation biopsy (SPBx) submitted to radical retropubic prostatectomy. Methods: From January 2005 to December 2008, 413 patients (median age 61.5 years) underwent SPBx (median 30 cores). A single neoplastic microfocus (5% or less of cancer in a single core) was found in 55 men and all patients underwent retropubic prostatectomy. Median PSA was equal to 8.2 ng/ml, digital rectal examination was negative and GS was 6 in 40 cases and not evaluable in 15 cases. Results: Prostatectomy specimens showed a significant cancer in 48/55 (87.3%) patients with a median GS of 6.2 (range 5–8), presence of extraprostatic extension and positive surgical margins in 15 (27.3%) and 8 (14.5%) cases, respectively. Six patients had an indolent PCa, and in 1 case no tumor was found. Conclusions: Patients with a single microfocal PCa diagnosed on SPBx corresponded to an insignificant cancer in surgical specimens only in 12.7% of cases, but they should be informed that they may harbor more aggressive disease with a risk of non-organ-confined cancer that in our series was 27.3%.

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Prostate Saturation Biopsy in the Reevaluation of Microfocal Prostate Cancer

Cited by 61 publications

References 10 publications

Is PCA3 Score Useful in Preoperative Staging of a Single Microfocus of Prostate Cancer Diagnosed at Saturation Biopsy

Is PCA3 Score Useful in Preoperative Staging of a Single Microfocus of Prostate Cancer Diagnosed at Saturation Biopsy

Contemporary Results of Focal Therapy for Prostate Cancer Using Cryoablation

Is a Single Focus of Low-Grade Prostate Cancer Diagnosed on Saturation Biopsy Predictive of Clinically Insignificant Cancer?

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