101
|
Merisaari H, Jambor I, Ettala O, Boström PJ, Montoya Perez I, Verho J, Kiviniemi A, Syvänen K, Kähkönen E, Eklund L, Pahikkala T, Vainio P, Saunavaara J, Aronen HJ, Taimen P. IMPROD biparametric MRI in men with a clinical suspicion of prostate cancer (IMPROD Trial): Sensitivity for prostate cancer detection in correlation with whole‐mount prostatectomy sections and implications for focal therapy. J Magn Reson Imaging 2019; 50:1641-1650. [DOI: 10.1002/jmri.26727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Harri Merisaari
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Ivan Jambor
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of RadiologyIcahn School of Medicine at Mount Sinai New York New York USA
| | - Otto Ettala
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Peter J. Boström
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Ileana Montoya Perez
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Janne Verho
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Aida Kiviniemi
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Kari Syvänen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Esa Kähkönen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Lauri Eklund
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Tapio Pahikkala
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Paula Vainio
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Jani Saunavaara
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Hannu J. Aronen
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Pekka Taimen
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| |
Collapse
|
102
|
|
103
|
van der Poel H, Grivas N, van Leeuwen P, Heijmink S, Schoots I. The role of MRI for detection and staging of radio- and focal therapy-recurrent prostate cancer. World J Urol 2019; 37:1485-1490. [DOI: 10.1007/s00345-019-02677-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022] Open
|
104
|
Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review. World J Urol 2019; 37:1517-1534. [DOI: 10.1007/s00345-019-02642-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/11/2019] [Indexed: 12/19/2022] Open
|
105
|
Reply to Massimo Valerio, Mark Emberton, and Hashim U. Ahmed's Letter to the Editor re: Henk G. van der Poel, Roderick C.N. van den Bergh, Erik Briers, et al. Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018;74:84–91. Eur Urol 2019; 75:e23-e24. [DOI: 10.1016/j.eururo.2018.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022]
|
106
|
Kluytmans A, Fütterer JJ, Emberton M, Sedelaar M, Grutters J. Exploring the risk-reward balance in focal therapy for prostate cancer-a contribution to the debate. Prostate Cancer Prostatic Dis 2019; 22:382-384. [PMID: 30664735 DOI: 10.1038/s41391-018-0125-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
Focal therapy (FT) for the treatment of localized prostate cancer offers an alternative strategy for men seeking active treatment. Although relatively new, existing studies suggest that the majority of men who undergo FT tend to maintain levels of genito-urinary function that are indistinguishable from their pre-treatment status. However, as part of the shared decision making process, men need to balance good tolerability against a greater risk of recurrence given that much of the prostate remains intact after FT. In order to explore this trade-off, we used decision modelling. Our findings show that the burden of functional complications associated with radical prostatectomy (RP) is considerable, as an average of 243 days of perfect health are lost per patient due to treatment-induced urinary incontinence and erectile dysfunction. Given this effectiveness gap in current care, we explored by how much mortality - as worst-case outcome of disease progression - could increase to still result in net health benefit. To do this we mapped the net health benefit/loss of FT, in comparison to RP, for different levels of function preservation and increases in mortality. We believe our modelling exercise might help inform future studies that seek to enhance our understanding of how men make treatment decisions.
Collapse
Affiliation(s)
- Anouck Kluytmans
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Mark Emberton
- Professor of Interventional Oncology, Division of Surgical and Interventional Science, University College London, London, United Kingdom
| | - Michiel Sedelaar
- Department of Urology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Janneke Grutters
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
| |
Collapse
|
107
|
Choi YH, Yu JW, Jeong BC, Seo SI, Jeon SS, Lee HM, Jeon HG. Histological characteristics of the largest and secondary tumors in radical prostatectomy specimens and implications for focal therapy. Diagn Pathol 2019; 14:2. [PMID: 30636627 PMCID: PMC6330453 DOI: 10.1186/s13000-019-0782-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/04/2019] [Indexed: 12/27/2022] Open
Abstract
Background Pathological features of prostate cancer in Korean men were analyzed to determine whether identification of tumor volume, Gleason score (GS), focality, and location using radical prostatectomy (RP) specimens can provide useful information for the application of focal therapy (hemiablation). Methods From January 2016 to December 2017, 913 patients who underwent RP at a single center were selected for analysis. Patients with prostate-specific antigen levels > 15 ng/mL or those who had received hormone therapy prior to surgery were excluded. Preoperative data and the number, volume, location, and GS of each tumor were recorded. Results Overall, 762 RP specimens were examined, and 1448 tumors were identified. The majority of the cases were multifocal (60.5%) and bilateral (82%) in nature. Among the 686 secondary tumors, 250 (36.4%) had a GS ≥7 and 122 (17.8%) had a tumor volume ≥ 0.5 mL. Among the 435 bilateral multifocal cases, secondary tumors on the lobes contralateral to the largest tumor were significant by volume (≥0.5 mL) in 91 (20.9%) cases and by grade (GS ≥7) in 179 (41.1%) cases. There were 102 (23.4%) tumors with a small tumor volume (< 0.5 mL) and Gleason pattern 4 on the lobe contralateral to the largest tumor. Conclusions Bilateral and multifocal tumors are a common feature and secondary tumors frequently exhibit clinically significant prostate cancer on RP specimens in Korea. In many cases, secondary tumors on the lobe contralateral to the largest tumor had a high GS and small tumor volume.
Collapse
Affiliation(s)
- Young Hyo Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ji Woong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| |
Collapse
|
108
|
Marra G, Ploussard G, Futterer J, Valerio M. Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach? World J Urol 2019; 37:277-287. [PMID: 30610359 DOI: 10.1007/s00345-018-02622-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP). METHODS We performed a literature search of peer-reviewed English language articles using PubMed and the words "prostate" AND "biopsy". Web search was implemented by manual search. RESULTS Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx-TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues. CONCLUSION The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.
Collapse
Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy.
| | - Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | |
Collapse
|
109
|
Choi YH, Yu JW, Kang MY, Sung HH, Jeong BC, Seo SI, Jeon SS, Lee HM, Jeon HG. Combination of multiparametric magnetic resonance imaging and transrectal ultrasound-guided prostate biopsies is not enough for identifying patients eligible for hemiablative focal therapy for prostate cancer. World J Urol 2019; 37:2129-2135. [DOI: 10.1007/s00345-018-02617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023] Open
|
110
|
Oncological long-term outcome of whole gland HIFU and open radical prostatectomy: a comparative analysis. World J Urol 2019; 37:2073-2080. [DOI: 10.1007/s00345-018-2613-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/19/2018] [Indexed: 12/25/2022] Open
|
111
|
|
112
|
Sanchez-Salas R, de la Rosette J, Polascik TJ, Carneiro A, Sivaraman A, Cathelineau X, Walz J. Focal Therapy for Prostate Cancer: A More Vehement View of the Approach Could Translate into Real Benefits for Our Patients. Eur Urol 2018; 74:537-539. [DOI: 10.1016/j.eururo.2018.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/16/2018] [Indexed: 01/20/2023]
|
113
|
Marra G, Ploussard G, Ost P, De Visschere PJL, Briganti A, Gandaglia G, Tilki D, Surcel CI, Tsaur I, Van Den Bergh RCN, Kretschmer A, Borgmann H, Gontero P, Ahmed HU, Valerio M. Focal therapy in localised prostate cancer: Real-world urological perspective explored in a cross-sectional European survey. Urol Oncol 2018; 36:529.e11-529.e22. [PMID: 30301698 DOI: 10.1016/j.urolonc.2018.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The urological community's opinion over focal therapy (FT) for prostate cancer (PCa) has never been assessed. Our aim was to investigate the current opinion on FT in the European urological community. METHODS A 25-item questionnaire was devised according to the Cherries checklist and distributed through SurveyMonkey using a web link from November 2016 to October 2017. After a pilot validation (n = 40 urologists), the survey was sent through EAU and 9 other national European urological societies mailing list. Twitter was also used. RESULTS We received 484 replies from 51 countries. Almost half (44.8%, n = 217) stated FT would represent a step forward, and 52.0% (n = 252) would suggest FT to a patient. Almost three-quarters (70.8%, n = 343) agreed FT will become a standard option after improvements in patient selection (n = 66) or when its effectiveness will be proven (n = 78), or both (n = 199). Most frequently used definition of FT was treatment of all significant (life-threatening) cancer foci whilst leaving untreated the rest of the gland (39.3%, n = 190). FT use was considered as an alternative to whole-gland treatments by 29.7% (n = 144), and to AS by 25.0% (n = 121). On multivariate analysis, FT availability and publications were associated with a positive opinion on FT. Conversely, attending International congresses, treating high PCa volumes and high percentages of high-risk PCa was associated with a negative opinion. CONCLUSIONS FT is considered as an attractive option for PCa treatment by the European urological community sampled by our survey. FT availability positively influences these thoughts. The present survey suggests whilst some early adopters already embraced FT, the relative majority of the urological community is prone to embrace FT in the near future, once current areas of debate are solved.
Collapse
Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy.
| | - Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Piet Ost
- Department of Urology and Radiology, Ghent University, Ghent, Belgium
| | | | - Alberto Briganti
- Department of Urology, Vita e Salute University and San Raffaele Hospital, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology, Vita e Salute University and San Raffaele Hospital, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg- Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg- Eppendorf, Hamburg, Germany
| | | | - Igor Tsaur
- Department of Urology, University of Mainz, Mainz, Germany
| | | | | | - Hendrik Borgmann
- Department of Urology, University Hospital of Mainz, Mainz, Germany
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | |
Collapse
|
114
|
Valerio M, Emberton M, Ahmed HU. Re: Henk G. van der Poel, Roderick C.N. van den Bergh, Erik Briers, et al. Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018;74:84-91. Eur Urol 2018; 75:e21-e22. [PMID: 30224194 DOI: 10.1016/j.eururo.2018.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
115
|
Tamihardja J, Zenk M, Flentje M. MRI-guided localization of the dominant intraprostatic lesion and dose analysis of volumetric modulated arc therapy planning for prostate cancer. Strahlenther Onkol 2018; 195:145-152. [PMID: 30209535 DOI: 10.1007/s00066-018-1364-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/23/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Primary radiation therapy is a curative treatment option for prostate cancer. The aim of this study was to evaluate the detection of the dominant intraprostatic lesion (DIL) with magnetic resonance imaging (MRI) for radiotherapy treatment planning, the comparison with transrectal ultrasound (TRUS)-guided biopsies and the examination of the dose distribution in relation to the DIL location. MATERIALS AND METHODS In all, 54 patients with treatment planning MRI for primary radiotherapy of prostate cancer from 03/2015 to 03/2017 at the Universitätsklinikum Würzburg were identified. The localization of the DIL was based on MRI with T2- and diffusion-weighted imaging. After registration of the MR image sets within Pinnacle3 (Philips Radiation Oncology Systems, Fitchburg, WI, USA), the dose distribution was analyzed. The location of the DIL was compared to the pathology reports in a side-based manner. RESULTS The DIL mean dose (Dmean) was 77.51 ± 0.77 Gy and in 50/51 cases within the tolerance range or exceeded the prescribed dose. There was a significant difference in Dmean between ventral (n = 21) and dorsal (n = 30) DIL (77.87 ± 0.67 vs. 77.26 ± 0.77 Gy; p = 0.005). MRI-guided localization showed an accuracy and sensitivity of up to 78.8% and 82.1% for inclusion of secondary lesions, respectively. CONCLUSION Up to 82.1% of histologically verified intraprostatic lesions were identified in the context of MRI-guided radiotherapy treatment planning. As expected, dorsal DIL tend to be minimally underdosed in comparison to ventral DIL. Adequate dose coverage was achieved in over 98% of patients.
Collapse
Affiliation(s)
- Jörg Tamihardja
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - Maria Zenk
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| |
Collapse
|
116
|
Active Surveillance for Low-risk Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018; 74:357-368. [DOI: 10.1016/j.eururo.2018.06.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/01/2018] [Indexed: 01/02/2023]
|
117
|
Demirel CH, Altok M, Davis JW. Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment? Asian J Androl 2018; 21:240302. [PMID: 30178774 PMCID: PMC6337958 DOI: 10.4103/aja.aja_64_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.
Collapse
Affiliation(s)
- Cihan H Demirel
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Muammer Altok
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| |
Collapse
|
118
|
Ashrafi AN, Nassiri N, Gill IS, Gulati M, Park D, de Castro Abreu AL. Contrast-Enhanced Transrectal Ultrasound in Focal Therapy for Prostate Cancer. Curr Urol Rep 2018; 19:87. [DOI: 10.1007/s11934-018-0836-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
119
|
Karnes RJ, MacKintosh FR, Morrell CH, Rawson L, Sprenkle PC, Kattan MW, Colicchia M, Neville TB. Prostate-Specific Antigen Trends Predict the Probability of Prostate Cancer in a Very Large U.S. Veterans Affairs Cohort. Front Oncol 2018; 8:296. [PMID: 30128303 PMCID: PMC6088151 DOI: 10.3389/fonc.2018.00296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/16/2018] [Indexed: 11/13/2022] Open
Abstract
If prostate-specific antigen (PSA) trends help identify elevated prostate cancer (PCa) risk, they might provide early warning of progressing cancer for further evaluation and justify annual testing. Our objective was to determine whether PSA trends predict PCa likelihood. A biopsy cohort of 361,657 men was obtained from a Veterans Affairs database (1999–2012). PSA trends were estimated for the 310,458 men with at least 2 PSA tests prior to biopsy. Cancer tumors may grow exponentially with cells doubling periodically. We hypothesized that PSA from prostate cancer grows exponentially above a no cancer baseline. We estimated PSA trends on that basis along with five descriptive variables: last PSA before biopsy, growth rate in PSA from cancer above a baseline, PSA variability around the trend, number of PSA tests, and time span of tests. PSA variability is a new variable that measures percentage deviations of PSA tests from estimated trends with 0% variability for a smoothly increasing trend. Logistic regression models were used to estimate relationships between the probability of PCa at biopsy and the trend variables and age. All five PSA trend variables and age were significant predictors of prostate cancer at biopsy (p < 0.0001). An overall logistic regression model achieved an AUC of 0.67 for men with at least 4 tests over at least 3 years, which was a substantial improvement over a single PSA (AUC 0.58). High probability of PCa was associated with low PSA variability (smooth trends), high PSA, high growth rate, many tests over a long time-span and older age. For example, at 4.0 PSA the probability of cancer is 32% for 1 PSA test and increases to 68% for 8 tests over 7 years with smooth, fast growth (0% variability and 50% exponential growth). Our results show that smooth, fast exponential growth in PSA above a baseline predicts an increased probability of PCa. The probability increases as smooth (low variability) trends are observed for more tests over a longer time span, which makes annual testing worth considering. Worrisome PSA trends might be used to trigger further evaluation and continued monitoring of the trends—even at low PSA levels.
Collapse
Affiliation(s)
| | | | - Christopher H Morrell
- Mathematics and Statistics Department, Loyola University Maryland, Baltimore, MD, United States
| | - Lori Rawson
- VA Sierra Nevada Health Care System, Reno, NV, United States
| | - Preston C Sprenkle
- VA Connecticut Healthcare System, Yale School of Medicine, New Haven, CT, United States
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Michele Colicchia
- Mayo Clinic, Rochester, MN, United States.,Urology, University of Padua, Padua, Italy
| | | |
Collapse
|
120
|
Murphy DG, Tilki D. Getting the Balance Right-The Benefits and Uncertainties of Focal Therapy for Significant Prostate Cancer. Eur Urol 2018; 74:430-431. [PMID: 30007818 DOI: 10.1016/j.eururo.2018.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
121
|
Abstract
The challenge to the urology community is to reduce the risks of screening and treatment by reducing the number of men undergoing unnecessary biopsy and whole-gland curative treatment of low-risk disease. There is compelling evidence that focal ablation of prostate cancer is truly minimally invasive and offers major functional advantages over whole-gland treatment.
Collapse
Affiliation(s)
- Herbert Lepor
- Department of Urology, NYU Langone Medical Center New York, NY
| | - Samuel Gold
- Department of Urology, NYU Langone Medical Center New York, NY
| | - James Wysock
- Department of Urology, NYU Langone Medical Center New York, NY
| |
Collapse
|