Jost von Hardenberg1, Angelika Borkowetz2, Fabian Siegel3, Kira Kornienko4, Niklas Westhoff5, Tobias B Jordan6, Manuela Hoffmann7, Martin Drerup8, Verena Lieb9, Kasra Taymoorian10, Martin Schostak11, Roman Ganzer12, Thomas Höfner13, Hannes Cash4, Johannes Bruendl6. 1. Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: jost.vonhardenberg@medma.uni-heidelberg.de. 2. Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 3. Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Heinrich-Lanz Center, Department of Biomedical Informatics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. 4. Department of Urology, Charité University Medicine Berlin, Berlin, Germany. 5. Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. 6. Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany. 7. Department of Occupational Health and Safety, Federal Ministry of Defense, Bonn, Germany. 8. Department of Urology, Paracelsus Medical University, Salzburg, Austria. 9. Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany. 10. Outpatient Urology Practice, Koblenz, Germany. 11. Clinic of Urology, Urooncology, Robotic-assisted and Focal Therapy, Medical Faculty and University Clinics of Magdeburg, Magdeburg, Germany. 12. Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany. 13. Department of Urology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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] ≤15ng/mL, and life expectancy >10yr), 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 <10ng/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.
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] ≤15ng/mL, and life expectancy >10yr), 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 <10ng/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.
Authors: Kira Kornienko; Fabian Siegel; Angelika Borkowetz; Manuela A Hoffmann; Martin Drerup; Verena Lieb; Johannes Bruendl; Thomas Höfner; Hannes Cash; Jost von Hardenberg; Niklas Westhoff Journal: Prostate Cancer Prostatic Dis Date: 2021-12-17 Impact factor: 5.455
Authors: Jost von Hardenberg; Hannes Cash; Daniel Koch; Angelika Borkowetz; Johannes Bruendl; Sami-Ramzi Leyh-Bannurah; Timur H Kuru; Karl-Friedrich Kowalewski; Daniel Schindele; Katharina S Mala; Niklas Westhoff; Andreas Blana; Martin Schostak Journal: World J Urol Date: 2021-04-21 Impact factor: 4.226