Original Paper
Urologia
Received: January 8, 2015 Accepted after revision: March 4, 2015 Published online: April 18, 2015
Urol Int 2015;95:197–202 DOI: 10.1159/000381559
Internationalis
Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy Lluís Fumadó a Lluís Cecchini a Nuria Juanpere b Anna Ubré a Jose Antonio Lorente c Antonio Alcaraz d
Departments of a Urology and b Pathology, Hospital del Mar, c Department of Urology, Hospital Quirón, and d Department of Urology, Hospital Clínic, Barcelona, Spain
Key Words Biopsy · Needle · Prostate cancer · Prostatectomy · Tumor burden, pathology · Staging
tion 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. © 2015 S. Karger AG, Basel
© 2015 S. Karger AG, Basel 0042–1138/15/0952–0197$39.50/0 E-Mail
[email protected] www.karger.com/uin
Introduction
In the last decades, the early detection strategies in prostate cancer (PCa) have achieved the migration to earlier stages [1] and lower tumour volumes [2] at diagnosis. This has led to the spread of new approaches of treatment such as focal therapy (FT) in an attempt to find the balance between cancer control and quality of life. The FT is designed to perform a targeted therapy with the goal of eradicating the index lesion (IL) and any significant PCa foci. The more frequent ablative template is the hemiablation, but it can also be performed as a targeted ablation or a zonal ablation [3]. The IL, defined as the largest tumour focus or the one with the highest Gleason score, drives the natural history of the disease [4–6]. The eligibility of an ideal candidate for FT is something that is yet to be defined, but is generally accepted in cases with unilateral PCa [7], mainly in Lluís Fumadó Department of Urology, Hospital del Mar Passeig Marítim, 25–29 ES–08003 Barcelona (Spain) E-Mail lfumado @ hospitaldelmar.cat
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Abstract 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 verylow-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 verylow-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 informa-
cases with unilateral Gleason 6 or 7 PCa [5]. In a recent consensus meeting, it has been proposed as a treatment option in cases of PSA 10 years, and any prostate volume [3]. Prostate biopsy (PB) information is one of the key criteria used to select an FT candidate. However, PB has several limitations in the correct classification of unilateral disease, in part related to the well-known PCa multifocality [8], and the intrinsic limitation of the random technique to achieve the anterior zone of the prostate. Moreover, there are confusing data regarding the association between the topographic information of PB and the radical prostatectomy (RP) specimen analysis [9]. In order to define the reliability of PB information in case of a patient eligible for an FT, we will describe the pathological features of RP specimens in potential candidates to TF by analysing the unexpected presence of bilateral disease, especially the presence of relevant disease – that is, significant PCa focus or the IL – in the contralateral lobe. A subanalysis will be performed in two stringent clinical selection criteria: unilateral Gleason 6 and unilateral very-low risk PCa.
810 radical prostatectomies for prostate cancer with curative intent Androgen deprivation therapy (n = 162) or radiotherapy (n = 20) prior to surgery n = 628 Gleason score 8 at prostate biopsy (n = 67) n = 561 Clinical stage >T2b (n = 18) n = 543 Bilateral prostate cancer at prostate biopsy (n = 219) n = 324 6 and/or tumour volume ≥0.5 cc in the RP specimen. The IL was defined as the largest tumour focus or the focus with the highest Gleason score. Two clinical subgroups were defined for comparative analysis: the unilateral Gleason 6 and the very low-risk prostate cancer (VLRPC) group. VLRPC was defined according the National Cancer Comprehensive Network (NCCN) [11] definition (T1c + Gleason ≤6 + PSA