Focal Therapy for Localized Prostate Cancer: A Critical Appraisal of Rationale and Modalities

Eggener, Scott E.; Scardino, Peter T.; Carroll, Peter R.; Zeléfsky, Michael J.; Sartor, Oliver; Hricak, Hedvig; Wheeler, Thomas M.; Fine, Samson W.; Trachtenberg, John; Rubin, Mark A.; Ohori, Mak; Kuroiwa, Kentaro; Rossignol, Michel; Abenhaim, Lucien

doi:10.1016/j.juro.2007.08.072

Cited by 311 publications

(183 citation statements)

References 46 publications

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“…Tumour cryoablation and high intensity focused ultrasound are well-known ablative techniques of FT and have been studied in the clinical setting. 16,17 Laser photothermal therapy and irreversible electroporation have been recently proposed as reliable alternatives, however their use is still under investigation. 18,19 The efficacy of FT has not been well-documented because of immature collective experience and relatively small patient cohorts.…”

Section: Discussionmentioning

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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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: 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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“…25 Unfortunately, our existing imaging technologies are not yet able to reliably confirm that a patient has unifocal disease. 26,27 And magnetic resonance imaging, the most successful imaging modality to date, has particular challenges identifying cancers in the prostate TZ.…”

Section: Potential Implicationsmentioning

confidence: 99%

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

Taira

Merrick

Galbreath

et al. 2009

Prostate Cancer Prostatic Dis

262

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Transrectal ultrasound (TRUS) biopsy can miss 20-30% of clinically significant cancers. We evaluate an alternative approach-transperineal template-guided mapping biopsy (TTMB) in the initial and repeat biopsy setting. From January 2005 through September 2008, 373 consecutive men underwent TTMB (294 men with X1 prior negative biopsy and 79 men as the initial biopsy). The location of each positive biopsy core, number of positive cores, and percent involvement of each core was recorded. Cancer detection rate for the initial biopsy was 75.9%. For men with 1, 2, and X3 prior negative biopsies detection rates were 55.5%, 41.7%, and 34.4%, respectively. In all, 55.5% of the cancers identified were Gleason X7. The majority of the cancers were multifocal. There was no significant change in the number of positive cores or Gleason score as the number of prior biopsies increased. The anterior and apical aspects of the prostate were among the most common cancer locations. TTMB provides a high rate of cancer detection as initial and repeat biopsy. TTMB was particularly effective at diagnosing anterior and apical cancer. TTMB may have particular application for men considering active surveillance, with prior negative TRUS biopsies, and those considering subtotal gland or other minimally invasive treatments.

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“…Due to the stage migration of prostate cancer, the potential for patients to undergo unnecessary treatment, and the risk of treatment-related morbidity, there has been an increased interest in management strategies that offer the possibility of delaying, 4 obviating 5 , or minimizing the impact of treatment 6 . One such strategy is active surveillance (AS) with selective delayed intervention.…”

Section: Introductionmentioning

confidence: 99%

A Multi-Institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer

et al. 2013

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Purpose-For select men with low-risk prostate cancer, active surveillance (AS) is more often being considered a management strategy. In a multicenter retrospective study we evaluated the actuarial rates and predictors of remaining on AS, incidence of cancer progression, and pathologic findings of delayed radical prostatectomy.Methods-A cohort of 262 men from four institutions met the following inclusion criteria: age ≤75, PSA ≤10 ng/ml, clinical stage T1-T2a, biopsy Gleason sum ≤6, ≤3 positive cores at diagnostic biopsy, a repeat biopsy before AS, and no treatment for six months following the repeat biopsy. AS started on the date of the second biopsy. Actuarial rates of remaining on AS were calculated and univariate Cox regression used to assess predictors of discontinuing AS.Results-With a median follow-up of 29 months 43 patients ultimately received active treatment. The two and five-year probabilities of remaining on AS were 91% and 75%, respectively. Patients with cancer on the second biopsy (HR=2.23; 95% CI: 1.23-4.06; p=0.007) and a higher number of cancerous cores from the two biopsies combined (p=0.002) were more likely to undergo treatment. Age, PSA, clinical stage, prostate volume, and number of total biopsy cores sampled were not predictive of outcome. One patient developed skeletal metastases 38 months after starting AS. Of the 43 patients undergoing delayed treatment, 41 (95%) are without disease progression at a median of 23 months following treatment.Conclusions-With a median follow-up of 29 months, AS for select patients appears to be safe and associated with a low risk of systemic progression. Cancer at restaging biopsy and a higher total number of cancerous cores are associated with a lower likelihood of remaining on AS. A restaging biopsy should be strongly considered to finalize eligibility for AS.

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Focal Therapy for Localized Prostate Cancer: A Critical Appraisal of Rationale and Modalities

Cited by 311 publications

References 46 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

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

A Multi-Institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer

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