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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

  • Young Hyo Choi
  • Ji Woong Yu
  • Min Yong Kang
  • Hyun Hwan Sung
  • Byong Chang Jeong
  • Seong Il Seo
  • Seong Soo Jeon
  • Hyun Moo Lee
  • Hwang Gyun JeonEmail author
Original Article

Abstract

Purpose

To evaluate focal therapy (hemiablation) eligibility in men undergoing prostate biopsy and multiparametric magnetic resonance imaging (mpMRI) with reference to histopathology from radical prostatectomy (RP) specimens.

Methods

Subjects were selected among 810 men who underwent prostate biopsy, mpMRI, and RP from January 2016 to December 2017. Hemiablation eligibility criteria were biopsy-proven unilateral cancer, prostate-specific antigen ≤ 15 ng/ml, and Gleason score (GS) ≤ 3 + 4. Evidence of non-organ-confined disease or Prostate Imaging Reporting and Data System score ≥ 4 on the contralateral lobe on mpMRI was classified as ineligible for hemiablation. Of the 810, data for 185 who met the screening criteria were compared to final pathology findings. Significant cancer at RP was defined as any of the following: (1) GS 6 with tumor volume ≥ 0.5 ml; (2) GS ≥ 3 + 4; or (3) the presence of advanced stage (≥ pT3).

Results

Among the 185 candidates for hemiablation, 62 (33.5%) had unilateral cancer on final RP histopathology. Among the 123 bilateral cancers, 50 (27%) were organ confined and had GS ≤ 3 + 4 = 7 and bilateral multifocal tumor in which the index tumor was confined to one lobe and the secondary tumor in the contralateral lobe had tumor volume < 0.5 ml and GS ≤ 6. A total of 112 (60.5%) patients in this series were considered suitable for hemiablation. Significant cancer on biopsy and mpMRI-negative lobes were found in 72 (38.9%) of 185 lobes, including 1 (0.5%) with advanced stage.

Conclusions

The combination of standard prostate biopsy and mpMRI did not accurately identify lobes that could be considered as non-treated regions.

Keywords

Focal therapy Hemiablation Magnetic resonance imaging Prostate biopsy Prostate cancer 

Notes

Authors’ contributions

YH Choi: data analysis, manuscript writing and editing, JW Yu: data collection and analysis, MY Kang: data analysis, HH Sung: data analysis, BC Jeong: data collection and management, SI Seo: data collection and management, SS Jeon: data collection and management, HM Lee: data analysis, HG Jeon: project development, data analysis, and supervision.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

345_2018_2617_MOESM1_ESM.jpg (130 kb)
Supplementary material 1 (JPEG 129 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Young Hyo Choi
    • 1
  • Ji Woong Yu
    • 1
  • Min Yong Kang
    • 1
  • Hyun Hwan Sung
    • 1
  • Byong Chang Jeong
    • 1
  • Seong Il Seo
    • 1
  • Seong Soo Jeon
    • 1
  • Hyun Moo Lee
    • 1
  • Hwang Gyun Jeon
    • 1
    Email author return OK on get
  1. 1.Department of Urology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

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