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Validation of the current eligibility criteria for focal therapy in men with localized prostate cancer and the role of MRI

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Abstract

Purpose

To validate current eligibility criteria for focal therapy (FT) in prostate cancer men undergoing radical prostatectomy (RP) and to assess the role of magnetic resonance imaging (MRI).

Methods

Retrospective analysis of 217 RP patients (2009–2016) with preoperative MRI (almost all in external institutions) and fulfillment of different FT eligibility criteria: unilateral tumor, clinical tumor stage ≤ cT2a, prostate volume ≤ 60 mL and either biopsy Gleason 3 + 3 or ≤ 3 + 4 and PSA ≤ 10 or ≤ 15 ng/mL. Multivariable logistic regression analyses (MVA) assessed the role of MRI to predict the presence of significant contralateral tumor or extracapsular extension (ECE), including seminal vesicle invasion. To quantify model accuracy, Receiver Operating Characteristics-derived area under the curve (AUC) was used.

Results

Of 217 patients fulfilling widest biopsy criteria and 113 fulfilling additional MRI criteria, 64 (29.7%) and 37 (32.7%) remained eligible for FT according to histopathological results. In MVA, fulfillment of MRI criteria reached independent predictor status for prediction of contralateral tumor but not for ECE. Addition of MRI resulted in AUC gain (57.5–64.6%). Sensitivity, specificity, PPV and NPV for MRI to predict contralateral tumor were: 41.8, 71.6, 70.9 and 42.6%, respectively. Virtually the same results were recorded for Gleason 3 + 3 and/or PSA ≤ 10 ng/mL.

Conclusions

Patient eligibility criteria for FT using biopsy criteria remained insufficient with respect to contralateral tumor disease. Although, MRI improves accuracy, it cannot safely exclude or minimize chance of significant cancer on contralateral prostate side. To date, stricter eligibility criteria are needed to provide more diagnostic reliability.

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Funding

This research received no specific Grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Raisa S. Pompe and Bieke Kühn-Thomä contributed equally.

Authors and Affiliations

  1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Raisa S. Pompe, Bieke Kühn-Thomä, Yamini Nagaraj, Valia Veleva, Felix Preisser, Sami-Ramzi Leyh-Bannurah, Markus Graefen, Hartwig Huland, Derya Tilki & Georg Salomon

  2. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Raisa S. Pompe, Sami-Ramzi Leyh-Bannurah & Derya Tilki

Authors
  1. Raisa S. Pompe
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  2. Bieke Kühn-Thomä
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  3. Yamini Nagaraj
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  4. Valia Veleva
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  5. Felix Preisser
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  7. Markus Graefen
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  10. Georg Salomon
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Contributions

RSP Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. BK.-T Data collection or management, Data analysis, Manuscript writing/editing. YN Protocol/project development, Manuscript writing/editing. VV Protocol/project development, Manuscript writing/editing. FP Protocol/project development, Data analysis, Manuscript writing/editing. S.-RL.-B Protocol/project development, Data analysis, Manuscript writing/editing. MG Protocol/project development, Data collection or management, Manuscript writing/editing. HH Protocol/project development, Data collection or management, Manuscript writing/editing. DT Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. GS Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing.

Corresponding author

Correspondence to Georg Salomon.

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The authors declare that they have no conflict of interest.

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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.

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Informed consent was obtained from all individual participants included in the study.

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Pompe, R.S., Kühn-Thomä, B., Nagaraj, Y. et al. Validation of the current eligibility criteria for focal therapy in men with localized prostate cancer and the role of MRI. World J Urol 36, 705–712 (2018). https://doi.org/10.1007/s00345-018-2238-2

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  • DOI: https://doi.org/10.1007/s00345-018-2238-2

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