Abstract
Background: Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy. Objective: To estimate the future potential of FT by analyzing the ...
Abstract
Background: Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy. Objective: To estimate the future potential of FT by analyzing the number of men eligible for FT among all men with biopsy-proven PCa and to judge the potential of different energy sources. Design, setting, and participants: Consensus criteria on FT were analyzed. Patients with biopsy-proven PCa from six tertiary referral hospitals and one outpatient practice in Germany had received a software-based combination biopsy. Men with Prostate Imaging Reporting and Data System (PI-RADS) >3 lesions based on PI-RADS v2 were included. Outcome measurements and statistical analysis: Patients were analyzed for potential treatment by FT and hemiablation. MRI lesions were mapped according to prostatic zones. Results and limitations: In total, 2371 patients were analyzed. According to consensus criteria (biopsy-proven unifocal lesion of International Society of Urological Pathology [ISUP] grade group <2, prostate-specific antigen [PSA] <15 ng/mL, and life expectancy >10 yr), 303 patients (12.8%; ISUP 1: n = 148 [6.2%]; ISUP 2: n = 155 [6.5%]) were potential candidates for FT. A maximum PSA level of <10 ng/mL would exclude further 60 (2.5%) of these men. The eligibility for hemiablation is slightly higher (16.2%). Unifocal lesions (n = 288) were equally distributed within the prostate (anteriorly [31%], apically [29%], and dorsally [36%]). Conclusions: With adherence to consensus statements, only a minority of PCa patients present as potential candidates for FT. Distribution of tumor localization suggests the need for different energy modalities to warrant an optimal FT treatment. Patient summary: We analyzed how many men who receive a magnetic resonance imaging-targeted and systematic prostate biopsy are candidates for the experimental focal therapy of the prostate. When following expert recommendations, only a small number of men are potential candidates for this alternative treatment. (c) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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