Buenos Aires, Argentina (UroToday.com) Dr. Linares-Quevedo from Infanta Sofia University Hospital discussed the correlation between standard biopsy and histology of lesions as detected on mpMRI as well as that on final pathology at radical prostatectomy (RP).
A total of 235 biopsy-naïve subjects with elevated PSA and/or abnormal DRE were retrospectively reviewed. All subjects underwent mpMRI and targeted biopsy of suspicious lesions detected on mpMRI. Of 96 patients, 68 (69%) underwent RP. Nine patients met the PRIAS definition which would make them candidates for focal therapy (all of these were clinical stage <T2b and Gleason score 6 by biopsy). According to the histology of mpMRI regions of interests found in RP specimens, 6 (67%) were Gleason 3+4 and 3 (33%) were Gleason 3+3. Based on these results, the authors concluded focal therapy can be performed safely based on mpMRI findings. I caution this interpretation as while mpMRI is an enhanced imaging modality, we also know the multifocality of prostate cancer and potential for up to 30% patients having disease (clinically significant as well) outside the focal treatment zone. This study, while provocative, lacks adequate numbers, potential confounding and selection bias to derive meaningful conclusions and/or recommendations to determine the oncologic efficacy and safety of focal therapies. Further research such as this in larger numbers are needed to ensure we are treating our patients with the most appropriate oncologic procedure, minimal morbidity and improve their QOL in the most cost effective manner.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.