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

Abstract

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.

Transperineal versus transrectal prostate biopsy for predicting the final laterality of prostate cancer: are they reliable enough to select patients for focal therapy? Results from a multicenter international study

“…Ongoing FT trials for PCa include the laterality, Gleason score and tumor volume as criteria for patient selection (1,12,16). The role of ultrasound and multiparametric MRI to define the exact disease localization is still debatable (12).…”

“…Recent pathologic studies from contemporary radical prostatectomy (RP) series have cited frequencies of unifocal prostate cancer (PCa) ranging from 10% to 44% and unilateral PCa ranging from 10% to 40% (1). In this context, focal therapy (both focal ablation and hemiablation) has progressively gained interest as a new method to control clinically localized PCa and has been defined as 'a type of treatment that aims to eradicate known cancer within the prostate and, at the same time, spare uninvolved prostatic tissue, with the aim of preserving genitourinary function' (2).…”

Focal Cryotherapy in the Treatment of Localized Prostate Cancer

“…This has led to considering a more preservative approach to treating prostate cancer, including hemi-ablation (half-gland treatment) and focal ablation. 8 Several diagnostic modalities are being investigated to improve the selection of candidates for focal therapy.…”

A clinical assessment of external beam focal therapy for localized prostate cancer measured by Gafchromic film

“…In fact, estimates have largely determined that up to around 78% of all cases of prostate cancer are multifocal malignancies [10]. However, through various individual studies and with the assistance of wholemounted specimens, it's been determined that it's the highest grade index lesion that drives the metastatic process of the prostate cancer [11].…”