Format

Send to

Choose Destination

See 1 citation found by title matching your search:

Eur Urol. 2014 Jul;66(1):12-9. doi: 10.1016/j.eururo.2013.09.045. Epub 2013 Oct 6.

Prostate cancer tumour features on template prostate-mapping biopsies: implications for focal therapy.

Author information

1
Division of Surgery and Interventional Sciences, University College London, London, UK.
2
Medical School, University College London, London, UK.
3
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
4
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Barts Cancer Institute, Queen Mary, University of London, London, UK.
5
Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK.
6
Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
7
Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: hashim.ahmed@ucl.ac.uk.

Abstract

BACKGROUND:

Focal therapy is being offered as a viable alternative for men with localised prostate cancer (PCa), but it is unclear which men may be suitable.

OBJECTIVE:

To determine the proportion of men with localised PCa who are potentially suitable for focal therapy.

DESIGN, SETTING, AND PARTICIPANTS:

Our institutional transperineal template prostate-mapping (TTPM) biopsy registry of 377 men from 2006 to 2010 identified 291 consecutive men with no prior treatment.

INTERVENTION:

TTPM biopsies using a 5-mm sampling frame.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Suitability for focal therapy required the cancer to be (1) unifocal, (2) unilateral, (3) bilateral/bifocal with at least one neurovascular bundle avoided, or (4) bilateral/multifocal with one dominant index lesion and secondary lesions with Gleason ≤3 + 3 and cancer core involvement ≤3 mm. Binary logistic regression modelling was used to determine variables predictive for focal therapy suitability.

RESULTS AND LIMITATIONS:

The median age was 61 yr, and the median prostate-specific antigen was 6.8 ng/ml. The median total was 29 cores, with a median of 8 positive cores. Of 239 of 291 men with cancer, 29% (70 men), 60% (144 men), and 8% (20 men) had low-, intermediate-, and high-risk PCa, respectively. Ninety-two percent (220 men) were suitable for one form of focal therapy: hemiablation (22%, 53 men), unifocal ablation (31%, 73 men), bilateral/bifocal ablation (14%, 33 men), and index lesion ablation (26%, 61 men). Binary logistic regression modelling incorporating transrectal biopsy parameters showed no statistically significant predictive variable. When incorporating TTPM parameters, only T stage was a significant negative predictor for suitability (p=0.001) (odds ratio: 0.001 [95% confidence interval, 0.000-0.048]). Limitations of the study include potential selection bias caused by tertiary referral practise and lack of long-term results on focal therapy efficacy.

CONCLUSIONS:

Focal therapy requires an accurate tool to localise individual cancer lesions. When such a test, TTPM biopsy, was applied to men with low- and intermediate-risk PCa, most of the men were suitable for a tissue preservation strategy.

KEYWORDS:

Biopsy; Diagnosis; Pathology; Prostate cancer; Surgery; Therapy

PMID:
24207133
PMCID:
PMC4062939
DOI:
10.1016/j.eururo.2013.09.045
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center