The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study
Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We colle...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/29/10/538 |
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| author | Alessio Paladini Giovanni Cochetti Alexandre Colau Martin Mouton Sara Ciarletti Graziano Felici Giuseppe Maiolino Federica Balzarini Philippe Sèbe Ettore Mearini |
| author_facet | Alessio Paladini Giovanni Cochetti Alexandre Colau Martin Mouton Sara Ciarletti Graziano Felici Giuseppe Maiolino Federica Balzarini Philippe Sèbe Ettore Mearini |
| author_sort | Alessio Paladini |
| collection | DOAJ |
| description | Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason Score (GS) of ≤7, ≤cT2a, PSA of ≤10 ng/mL, and GS 6 on a random biopsy with ≤2 positive foci out of 12. Potential oncological safety of FT was defined as the respect of clinicopathological inclusion criteria on histology specimens, no extracapsular extension, and no biochemical, local, or metastatic recurrence within 12 months. To predict FT failure, we performed uni- and multivariate logistic regression. Sixty-seven patients were enrolled. The MRI index lesion median size was 11 mm; target lesions were ISUP grade 1 in 27 patients and ISUP grade 2 in 40. Potential FT failure occurred in 32 patients, and only the PSA value resulted as a predictive parameter (<i>p</i> < 0.05). The main issue for FT is patient selection, mainly because of multifocal csPCa foci. Nevertheless, FT could represent a therapeutic alternative for highly selected low-risk PCa patients. |
| first_indexed | 2024-03-09T20:24:33Z |
| format | Article |
| id | doaj.art-b5dda6e5a12f4c5885d5016450607efa |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T20:24:33Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-b5dda6e5a12f4c5885d5016450607efa2023-11-23T23:39:45ZengMDPI AGCurrent Oncology1198-00521718-77292022-09-0129106826683310.3390/curroncol29100538The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre StudyAlessio Paladini0Giovanni Cochetti1Alexandre Colau2Martin Mouton3Sara Ciarletti4Graziano Felici5Giuseppe Maiolino6Federica Balzarini7Philippe Sèbe8Ettore Mearini9Urology Clinic, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, ItalyUrology Clinic, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, ItalyChirurgie Urologique, Hôpital Croix Saint Simon Groupe Diaconesses, 75020 Paris, FranceChirurgie Urologique, Hôpital Croix Saint Simon Groupe Diaconesses, 75020 Paris, FranceUrology Clinic, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, ItalyUrology Clinic, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, ItalyUrology Clinic, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, ItalyChirurgie Urologique, Hôpital Croix Saint Simon Groupe Diaconesses, 75020 Paris, FranceChirurgie Urologique, Hôpital Croix Saint Simon Groupe Diaconesses, 75020 Paris, FranceUrology Clinic, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, ItalyIncreased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason Score (GS) of ≤7, ≤cT2a, PSA of ≤10 ng/mL, and GS 6 on a random biopsy with ≤2 positive foci out of 12. Potential oncological safety of FT was defined as the respect of clinicopathological inclusion criteria on histology specimens, no extracapsular extension, and no biochemical, local, or metastatic recurrence within 12 months. To predict FT failure, we performed uni- and multivariate logistic regression. Sixty-seven patients were enrolled. The MRI index lesion median size was 11 mm; target lesions were ISUP grade 1 in 27 patients and ISUP grade 2 in 40. Potential FT failure occurred in 32 patients, and only the PSA value resulted as a predictive parameter (<i>p</i> < 0.05). The main issue for FT is patient selection, mainly because of multifocal csPCa foci. Nevertheless, FT could represent a therapeutic alternative for highly selected low-risk PCa patients.https://www.mdpi.com/1718-7729/29/10/538prostate cancerfocal therapylow-risk PCaMRIPSA |
| spellingShingle | Alessio Paladini Giovanni Cochetti Alexandre Colau Martin Mouton Sara Ciarletti Graziano Felici Giuseppe Maiolino Federica Balzarini Philippe Sèbe Ettore Mearini The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study Current Oncology prostate cancer focal therapy low-risk PCa MRI PSA |
| title | The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study |
| title_full | The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study |
| title_fullStr | The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study |
| title_full_unstemmed | The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study |
| title_short | The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study |
| title_sort | challenges of patient selection for prostate cancer focal therapy a retrospective observational multicentre study |
| topic | prostate cancer focal therapy low-risk PCa MRI PSA |
| url | https://www.mdpi.com/1718-7729/29/10/538 |
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