Are we able to correctly identify prostate cancer patients who could be adequately treated by focal therapy?

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorKATZ, Betina
dc.contributor.authorSROUGI, Miguel
dc.contributor.authorDALL'OGLIO, Marcos
dc.contributor.authorNESRALLAH, Adriano J.
dc.contributor.authorSANT'ANNA, Alexandre C.
dc.contributor.authorPONTES JR., Jose
dc.contributor.authorREIS, Sabrina T.
dc.contributor.authorSANUDO, Adriana
dc.contributor.authorCAMARA-LOPES, Luiz H.
dc.contributor.authorLEITE, Katia R. M.
dc.date.accessioned2013-07-30T14:39:09Z
dc.date.available2013-07-30T14:39:09Z
dc.date.issued2012
dc.description.abstractIntroduction and Objective: Because of the improvements on detection of early stage prostate cancer over the last decade, focal therapy for localized prostate cancer (PC) has been proposed for patients with low-risk disease. Such treatment would allow the control of cancer, thereby diminishing side effects, such as urinary incontinence and sexual dysfunction, which have an enormous impact on quality of life. The critical issue is whether it is possible to preoperatively predict clinically significant unifocal or unilateral prostate cancer with sufficient accuracy. Our aim is to determine whether there is any preoperative feature that can help select the ideal patient for focal therapy. Material and methods: A total of 599 patients who underwent transrectal ultrasound, (TRUS)-guided prostate biopsy followed by radical prostatectomy to treat PC were examined in our laboratory between 2001 and 2009. We established very restricted criteria to select patients with very-low-risk disease for whom focal therapy would be suitable (only I biopsy core positive, tumor no larger than 80% of a single core, no perineural invasion, PSA serum level < 10 ng/ml, Gleason score < 7 and clinical stage T1c, T2a-b). We defined 2 groups of patients who would be either adequately treated or not treated by focal therapy. The primary endpoint was the evaluation of preoperative features in order to identify which parameters should be considered when choosing good candidates for focal therapy. Results: Fifty-six out of 599 patients met our criteria. The mean age was 59 years, and the mean number of biopsy cores was 14.4. Forty-seven (83.9%) were staged T1c, and 9 (16.1%) were staged T2a-b. Forty-four (78.6%) patients could be considered to have been adequately treated by focal therapy, and 12 (21.4%) could not. There was no statistical difference between the 2 groups considering age, clinical stage, PSA levels, Gleason score, and tumor volume in the biopsy. All 12 patients who could be considered inadequately treated had a bilateral, significant secondary tumor, 58.3% had Gleason >= 7, and 25% were staged pT3. Conclusion: Although focal therapy might be a good option for patients with localized prostate cancer, we are so far unable to select which of them would benefit from it based on preoperative data, even using very restricted criteria, and a considerable proportion of men would still be left undertreated.
dc.description.indexMEDLINE
dc.identifier.citationUROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, v.30, n.6, p.794-797, 2012
dc.identifier.doi10.1016/j.urolonc.2010.10.010
dc.identifier.issn1078-1439
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/365
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INC
dc.relation.ispartofUrologic Oncology-Seminars and Original Investigations
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCIENCE INC
dc.subjectFocal therapy
dc.subjectRisk stratification multifocal
dc.subjectIndex lesion
dc.subject.otherbiopsy
dc.subject.wosOncology
dc.subject.wosUrology & Nephrology
dc.titleAre we able to correctly identify prostate cancer patients who could be adequately treated by focal therapy?
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalKATZ, Betina:Lab Surg & Mol Pathol, Sao Paulo, Brazil
hcfmusp.author.externalSANT'ANNA, Alexandre C.:Lab Surg & Mol Pathol, Sao Paulo, Brazil
hcfmusp.author.externalSANUDO, Adriana:Univ Sao Paulo, Sch Med, Dept Urol, Lab Med Invest, Sao Paulo, Brazil
hcfmusp.author.externalCAMARA-LOPES, Luiz H.:Lab Surg & Mol Pathol, Sao Paulo, Brazil
hcfmusp.citation.scopus7
hcfmusp.contributor.author-fmusphcMIGUEL SROUGI
hcfmusp.contributor.author-fmusphcMARCOS FRANCISCO DALL'OGLIO
hcfmusp.contributor.author-fmusphcADRIANO JOAO NESRALLAH
hcfmusp.contributor.author-fmusphcJOSE PONTES JUNIOR
hcfmusp.contributor.author-fmusphcSABRINA THALITA DOS REIS FARIA
hcfmusp.contributor.author-fmusphcKATIA RAMOS MOREIRA LEITE
hcfmusp.description.beginpage794
hcfmusp.description.endpage797
hcfmusp.description.issue6
hcfmusp.description.volume30
hcfmusp.lim.ref2012
hcfmusp.origemWOS
hcfmusp.origem.pubmed21458310
hcfmusp.origem.scopus2-s2.0-84870518443
hcfmusp.origem.wosWOS:000312511300007
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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