Three-Dimensional Prostate Mapping Biopsy Has a Potentially Significant Impact on Prostate Cancer Management

Onik, Gary; Miessau, Matthew; Bostwick, David G.

doi:10.1200/jco.2008.20.3497

Cited by 186 publications

(94 citation statements)

References 13 publications

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“…TPM appears to be the gold standard for intraprostatic detection and localization 29 ; it has the added advantage that the needle does not traverse rectal mucosa, thus minimizing injury to an area that has poor tissue viability from previous radiation exposure. 30 Although, in the interim, TPM ideally should be used to histologically verify localized recurrence, mp-MRI is likely to be used increasingly for this purpose followed by targeted biopsies.…”

Section: Discussionmentioning

confidence: 99%

Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy

Ahmed

Cathcart

McCartan

et al. 2012

Cancer

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BACKGROUND:The objective of this study was to evaluate the safety, feasibility, side-effect profile, and proof of concept for focal salvage therapy using high-intensity focused ultrasound (HIFU). METHODS: A registry-based analysis was conducted between 2004 and 2009 of 430 patients who underwent HIFU. Thirty-nine patients received focal salvage therapy for localized recurrence after external beam radiotherapy. Multiparametric magnetic resonance imaging studies combined with transperineal template prostate mapping biopsies or transrectal biopsies were used to localize disease. Validated questionnaires were used to assess functional outcomes. Biochemical failure was defined by using both Phoenix criteria (prostate-specific antigen [PSA] nadir plus 2 ng/mL) and Stuttgart criteria (PSA nadir plus 1.2 ng/mL). RESULTS: The mean pre-HIFU PSA level was 4.6 ng/mL. The median follow-up was 17 months (interquartile range, 10-29 months). International Index of Erectile Function-5 scores decreased from a median AE standard deviation (SD) of 18 AE 16 to 13 AE 21 at 6 months, demonstrating worsening function. Scores on the University of California Los Angeles-Expanded Prostate Cancer Index Composite Urinary domain indicate that pad-free, leak-free continence status was 64%, and the pad-free rate was 87.2% at last follow-up. One rectourethral fistula occurred and spontaneously resolved with urinary and bowel diversion. The actuarial progression-free survival rate (including PSA nonresponders) was 69% at 1 year and 49% at 2 years according to Phoenix criteria. Excluding PSA nonresponders, these rates were 74% and 58%, respectively (Phoenix criteria). CONCLUSIONS: The results from this study indicated that focal salvage therapy is a potential strategy for localized recurrence after radiotherapy that may reduce the harms resulting from whole-gland salvage therapies. Cancer 2012;118:4148-55. V C 2012 American Cancer Society.KEYWORDS: focal, salvage, high-intensity focused ultrasound, prostate cancer, external beam radiotherapy. INTRODUCTIONBiochemical failure in men who have undergone external beam radiation therapy (EBRT) for localized prostate cancer can occur in approximately 10% to 30%. 1-3 The biochemical control rates observed are significantly better with high-dose radiation compared with conventional doses. However, most men who fail EBRT receive androgen-deprivation therapy, which can have an impact on quality of life and cardiac, metabolic, and bone health. 4,5 However, many patients have localized disease that may be suitable for local salvage therapy using surgery, brachytherapy, cryotherapy, or high-intensity focused ultrasound (HIFU). Those who undergo whole-gland salvage therapy have a significant risk of genitourinary and bowel complications, because the viability of surrounding tissues may have been compromised by previous radiation. The biochemical cancer control rates that result from these salvage therapies are on the order of 40% to 60% over 2 to 5 years follow-up. [6][7][8] We previously reported our early res...

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Section: Discussionmentioning

confidence: 99%

Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy

Ahmed

Cathcart

McCartan

et al. 2012

Cancer

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“…Inadequate identification of unilateral cancers was a major clinical problem in the FT implementation and, for this reason, new imaging modalities and biopsy techniques have been evaluated to better map prostate cancer within the gland. [9][10][11] Although the results are interesting, the efficacy, safety and superiority compared to conventional imaging and biopsy schemes will need to be determined before these approaches become standard.…”

Section: Discussionmentioning

confidence: 99%

“…Three-dimensional transperineal mapping biopsies are promising, since they can be used either as a selection tool for FT candidates by identifying cancer location and extension within the prostate, or as a guide for the FT procedure. 11 However, hospitalization and general anesthesia are needed and, therefore, its use is limited.…”

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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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“…17 There existed unanimous agreement that the current gold standard for characterizing men who are considering focal therapy is transperineal prostate biopsy using a templateguided approach. 18,19 When used with a 5-mm sampling frame, this approach can rule in and rule out prostate cancer foci of 0.5 cc and 0.2 cc volume with 90% certainty. 20 It was accepted that this approach is not yet widely available and carried a high burden on healthcare services because Evaluation of outcome and follow-up of its requirement for anesthesia, pathology processing, and reporting time.…”

Section: Assessment Of Patients Who May Be Candidates For Focal Therapymentioning

confidence: 99%

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Rosette

Ahmed

Barentsz³

et al. 2010

Journal of Endourology

172

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Purpose: To establish a consensus in relation to case selection, conduct of therapy, and outcomes that are associated with focal therapy for men with localized prostate cancer. Material and Methods: Urologic surgeons, radiation oncologists, radiologists, and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer. The consensus process was face to face within a structured meeting, in which pertinent clinical issues were raised, discussed, and agreement sought. Where no agreement was possible, this was acknowledged, and the nature of the disagreement noted. Results: Candidates for focal treatment should have unilateral low-to intermediate-risk disease with clinical stage cT 2a . Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used. Currently, the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies. MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results. For general use, however, these new techniques require validation in prospective clinical trials. Until such are performed, MRI will, in most centers, continue to be an investigative tool in assessing eligibility of patients for focal therapy. Conclusions: Consensus was derived for most of the key aspects of case selection, conduct of treatment, and outcome measures for men who are undergoing focal therapy for localized prostate cancer. The level of agreement achieved will pave the way for future collaborative trials.

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Three-Dimensional Prostate Mapping Biopsy Has a Potentially Significant Impact on Prostate Cancer Management

Abstract: 3D-PMB is a transperineal biopsy that can be safely used to accurately stage prostate cancer patients. At the present time, when patient management is increasingly based on the extent and characteristics of prostate cancer, 3D-PMB could have a profound effect on patient management.

Cited by 186 publications

References 13 publications

Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy

Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

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