Portal de Periódicos da CAPES

Laterality Alone Should Not Drive Selection of Candidates for Hemi-Ablative Focal Therapy

2009; Lippincott Williams & Wilkins; Volume: 181; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2008.10.155

1527-3792

Basir Tareen, Guilherme Godoy, Alex Sankin, Steve Temkin, Herbert Lepor, Samir S. Taneja,

Venous Thromboembolism Diagnosis and Management

No AccessJournal of UrologyAdult Urology1 Mar 2009Laterality Alone Should Not Drive Selection of Candidates for Hemi-Ablative Focal Therapy Basir Tareen, Guilherme Godoy, Alex Sankin, Steve Temkin, Herbert Lepor, and Samir S. Taneja Basir TareenBasir Tareen More articles by this author , Guilherme GodoyGuilherme Godoy More articles by this author , Alex SankinAlex Sankin More articles by this author , Steve TemkinSteve Temkin More articles by this author , Herbert LeporHerbert Lepor Financial interest and/or other relationship with Med Reviews and US HIFU. More articles by this author , and Samir S. TanejaSamir S. Taneja Financial interest and/or other relationship with GTX, Envisioneering and GlaxoSmithKline. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.10.155AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Because many investigators have suggested that ideal candidates for focal therapy are those with unilateral prostate cancer, we evaluated whether these men are at decreased risk for adverse pathological and oncological outcomes. Materials and Methods: We reviewed the charts of 1,458 consecutive patients who underwent open radical prostatectomy, as performed by a single surgeon. Patients were divided into 311 with unilateral (group 1) and 1,147 with bilateral (group 2) disease on final surgical pathology. They were also substratified by clinical risk into low risk (prostate specific antigen less than 10 ng/ml, clinical stage less than T2b or Gleason score less than 7) and high risk groups. The groups were compared with respect to extracapsular extension, seminal vesical invasion, percent of tumor involvement, pathological Gleason score and biochemical recurrence. Results: Compared to patients with bilateral disease those with unilateral disease had a lower rate of extracapsular extension (p = 0.004), seminal vesical invasion (p = 0.003), greater than 10% tumor involvement (p <0.001) and Gleason score 7 or greater (p <0.001). At a median followup of 36 months 8.3% and 16.7% of the men in groups 1 and 2, respectively, experienced biochemical recurrence (p = 0.001). Low risk disease was more prevalent in those with unilateral disease than in those with bilateral disease. Of men with low risk disease the risk of adverse pathological features/biochemical recurrence did not differ between groups 1 and 2. Conclusions: Although men with unilateral prostate cancer have more favorable oncological outcomes than those with bilateral prostate cancer, this appears to be due to the higher prevalence of low risk disease. While focality/laterality may direct the method of subtotal gland treatment, clinical risk features may be adequate to select candidates for focal therapy. References 1 : Early stage prostate cancer—do we have a problem with over-detection, overtreatment or both?. J Urol2005; 173: 1061. Link, Google Scholar 2 : Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: results from CaPSURE. J Urol2003; 170: 1804. Link, Google Scholar 3 : The contemporary management of prostate cancer in the United States: lessons from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national disease registry. J Urol2004; 171: 1393. Link, Google Scholar 4 : Analysis of laterality and percentage of tumor involvement in 1386 prostatectomized specimens for selection of unilateral focal cryotherapy. Technol Cancer Res Treat2007; 6: 91. Google Scholar 5 : Predicting unilateral prostate cancer based on biopsy features: implications for focal ablative therapy—results from the SEARCH database. J Urol2007; 178: 1249. Link, Google Scholar 6 : Can prostate biopsies predict suitability for nerve-sparing radical prostatectomy?. Scand J Urol Nephrol2004; 38: 216. Google Scholar 7 : Accuracy of prostate needle biopsy in predicting extracapsular tumor extension at radical retropubic prostatectomy: application in selecting patients for nerve-sparing surgery. Urology1998; 52: 814. Google Scholar 8 : Pathology of the Prostate. Philadelphia: WB Saunders Co1998. p 72. Google Scholar 9 : “Male lumpectomy”: focal therapy for prostate cancer using cryoablation. Urology2007; 70: 16. Google Scholar 10 : Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology2007; 69: 1117. Google Scholar 11 : Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens. Mod Pathol2005; 18: 1022. Google Scholar 12 : Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. J Urol2003; 170: 459. Link, Google Scholar 13 : Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology2002; 60: 264. Google Scholar 14 : Is focal therapy reasonable with early stage prostate cancer—an analysis of radical prostatectomy specimens. J Urol2006; 175: 507. abstract 1574. Link, Google Scholar 15 : Cryosurgical ablation of the prostate: high risk patient outcomes. Cancer2005; 103: 1625. Google Scholar 16 : Prostate cancer laterality does not predict prostate-specific antigen recurrence after radical prostatectomy. Urology2007; 70: 1141. Google Scholar 17 : Difference of cancer core distribution between first and repeat biopsy in patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy. Prostate2004; 58: 76. Google Scholar 18 : Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer. Cancer2007; 110: 906. Google Scholar 19 : Do biopsy characteristics predict unilateral prostate cancer on radical prostatectomy?. Eur Urol2008; 7: 252. Google Scholar 20 : Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol2007; 177: 540. Link, Google Scholar Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byWilliams C, Khondakar N, Daneshvar M, O’Connor L, Gomella P, Mehralivand S, Yerram N, Egan J, Gurram S, Rompré-Brodeur A, Webster B, Owens-Walton J, Parnes H, Merino M, Wood B, Choyke P, Turkbey B and Pinto P (2021) The Risk of Prostate Cancer Progression in Active Surveillance Patients with Bilateral Disease Detected by Combined Magnetic Resonance Imaging-Fusion and Systematic BiopsyJournal of Urology, VOL. 206, NO. 5, (1157-1165), Online publication date: 1-Nov-2021.Masterson T, Cheng L, Mehan R and Koch M (2011) Tumor Focality Does Not Predict Biochemical Recurrence After Radical Prostatectomy in Men With Clinically Localized Prostate CancerJournal of Urology, VOL. 186, NO. 2, (506-510), Online publication date: 1-Aug-2011.Jeong I, Kim J, Cho K, You D, Song C, Hong J, Ahn H and Kim C (2010) Diffusion-Weighted Magnetic Resonance Imaging in Patients With Unilateral Prostate Cancer on Extended Prostate Biopsy: Predictive Accuracy of Laterality and Implications for Hemi-Ablative TherapyJournal of Urology, VOL. 184, NO. 5, (1963-1970), Online publication date: 1-Nov-2010. Volume 181Issue 3March 2009Page: 1082-1090 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsprostatic neoplasmsprostateriskfunctional lateralityoutcome assessment (health care)MetricsAuthor Information Basir Tareen More articles by this author Guilherme Godoy More articles by this author Alex Sankin More articles by this author Steve Temkin More articles by this author Herbert Lepor Financial interest and/or other relationship with Med Reviews and US HIFU. More articles by this author Samir S. Taneja Financial interest and/or other relationship with GTX, Envisioneering and GlaxoSmithKline. More articles by this author Expand All Advertisement PDF downloadLoading ...