Objective
To provide insights into the role of multiparametric magnetic resonance imaging (mpMRI)
in predicting oncological control following 2 focal ablation (FA) templates for selective
cases of prostate cancer.
Materials and Methods
A total of 59 radical prostatectomies were performed between 2012 and 2016 on cases
that fulfilled criteria for FA. The Gleason score (GS), extent of Gleason pattern
(GP) 4, maximum linear cross-sectional length (MLCSL), and location of tumor foci
were recorded and related to scale on corresponding 3-mm transverse slice prostate
maps. Gleason pattern 4 extra-focal disease (GP4EFD) was defined as prostate cancer
with any GP 4 not detected by mpMRI and transrectal ultrasound systematic biopsy observed
outside a specified ablation zone. The location of these GP4EFD relative to the MRI
lesion (MRI-L) (contralateral or ipsilateral) was recorded and used to predict oncological
control following a hypothetical margin and ipsilateral hemi-ablation templates.
Results
Overall, 15 of 59 (25.4%) of the prostate specimens had at least 1 GP4EFD. Of the
total 20 GP4EFD, 7 of 20 (35%) were ipsilateral and 13 of 20 (65%) were contralateral
to the MRI-L. Of the GP4EFD, 16 of 20 (80%), 2 of 20 (10%), and 2 of 20 (10%) were
GS 3 + 4, GS 4 + 3, and GS 4 + 4, respectively. Of these GP4EFD, 10 of 20 (50%) exhibited
an MLCSL <5 mm. Ablating only the MRI-L+10 mm or performing an ipsilateral hemi-ablation
would leave residual GP4 in 14 of 59 (23.7%) and 11 of 59 (18.6%) of cases, respectively.
Conclusion
Because a significant proportion of candidates for FA based on mpMRI and systematic
biopsy will have pre-existing GP4EFD outside ablation templates, active surveillance
of the untreated prostate is mandatory.
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Article info
Publication history
Published online: October 20, 2017
Accepted:
October 10,
2017
Received:
August 15,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
