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Multifocality of Prostate Cancer and Candidacy for Focal Therapy Based on Magnetic Resonance Imaging

      Abstract

      Objectives

      To determine the prevalence of multiparametric magnetic resonance imaging (mpMRI)-detected and targeted biopsy-confirmed multifocal and unifocal prostate cancer (PCa) among patients with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions. Focal therapy (FT) options for PCa are tied to accurate spatial identification on mpMRI.

      Methods

      Men without prior diagnosis of PCa receiving mpMRI, targeted and systematic prostate biopsy in the Prospective Loyola Urology mpMRI (PLUM) Prostate Biopsy Cohort from 2015-2021 were included. Patients with PI-RADS ≥3 lesions were classified by mpMRI lesion location, targeted biopsy, and systematic biopsy. Patients with single biopsy-confirmed grade group (GG) 2 lesions and concordant systematic biopsy were defined as FT candidates. Multivariable logistic regression evaluated predictors of mpMRI-undetected contralateral PCa.

      Results

      Of 897 patients, 450 (50.2%) had a single, 141 (15.7%) had multiple unilateral, and 306 (34.1%) had bilateral mpMRI lesions. 28.7% had a single targeted biopsy-confirmed lesion while 10.4% were multifocal. Among single targeted biopsy-confirmed patients, 92/257 (35.8%) had contralateral PCa missed by mpMRI with DRE, PSA, and biopsy history identified as independent predictors. Systematic biopsy findings dropped the rate of single confirmed lesions from 28.7% to 18.4% and multifocal PCa increased from 10.4% to 20.6%. After GG restrictions, 61/897 (6.8%) remained potential FT candidates.

      Conclusions

      Among men with clinical suspicion of prostate cancer receiving mpMRI, 28.7% had a single targeted biopsy-confirmed lesion and 10.4% had multifocality on mpMRI, but many mpMRI-undetected contralateral PCa were identified. Only 6.0% of biopsy-naïve men remained with a single GG2 mpMRI lesion potentially amenable to FT.
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      References

        • Siegel RL
        • Miller KD
        • Fuchs HE
        • et al.
        Cancer statistics, 2022.
        CA Cancer J Clin. 2022 Jan; 72: 7-33
        • Su ZT
        • Patel HD
        • Epstein JI
        • et al.
        Downgrading of grade group 2 intermediate-risk prostate cancer from biopsy to radical prostatectomy: Comparison of outcomes and predictors to identify potential candidates for active surveillance.
        Cancer. 2020 Apr 15; 126: 1632-1639
        • Habchi H
        • Bratan F
        • Paye A
        • et al.
        Value of prostate multiparametric magnetic resonance imaging for predicting biopsy results in first or repeat biopsy.
        Clin Radiol. 2014 Mar; 69: e120-e128
        • Johnson DC
        • Reiter RE.
        Multi-parametric magnetic resonance imaging as a management decision tool.
        Transl Androl Urol. 2017 Jun; 6: 472-482
        • Kasivisvanathan V
        • Rannikko AS
        • Borghi M
        • et al.
        MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis.
        N Engl J Med. 2018 May 10; 378: 1767-1777
        • Patel HD
        • Koehne EL
        • Shea SM
        • et al.
        Systematic versus Targeted Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy among Men with Visible Lesions.
        J Urol. 2022 Jan; 207: 108-117
        • Muller BG
        • Fütterer JJ
        • Gupta RT
        • et al.
        The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel.
        BJU Int. 2014 Feb; 113: 218-227
        • Nassiri N
        • Chang E
        • Lieu P
        • et al.
        Focal Therapy Eligibility Determined by Magnetic Resonance Imaging/Ultrasound Fusion Biopsy.
        J Urol. 2018 Feb; 199: 453-458
        • Choi YH
        • Yu JW
        • Kang MY
        • et al.
        Combination of multiparametric magnetic resonance imaging and transrectal ultrasound-guided prostate biopsies is not enough for identifying patients eligible for hemiablative focal therapy for prostate cancer.
        World J Urol. 2019 Oct; 37: 2129-2135
        • Hong CW
        • Rais-Bahrami S
        • Walton-Diaz A
        • et al.
        Comparison of magnetic resonance imaging and ultrasound (MRI-US) fusion-guided prostate biopsies obtained from aial and sagittal approaches.
        BJU Int. 2015 May; 115: 772-779
        • Natarajan S
        • Jones TA
        • Priester AM
        • et al.
        Focal Laser Ablation of Prostate Cancer: Feasibility of Magnetic Resonance Imaging-Ultrasound Fusion for Guidance.
        J Urol. 2017 Oct; 198: 839-847
      1. Schaeffer E, Srinivas S, Antonarakis ES, et al. NCCN Guidelines: Prostate Cancer, Version 3.2022

        • Eggener SE
        • Yousuf A
        • Watson S
        • et al.
        Phase II Evaluation of Magnetic Resonance Imaging Guided Focal Laser Ablation of Prostate Cancer.
        J Urol. 2016 Dec; 196: 1670-1675
        • Lindner U
        • Weersink RA
        • Haider MA
        • Gertner MR
        • Davidson SR
        • Atri M
        • Wilson BC
        • Fenster A
        • Trachtenberg J.
        Image guided photothermal focal therapy for localized prostate cancer: phase I trial.
        J Urol. 2009 Oct; 182: 1371-1377
        • Feijoo ER
        • Sivaraman A
        • Barret E
        • et al.
        Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes.
        Eur Urol. 2016 Feb; 69: 214-220
        • Ganzer R
        • Hadaschik B
        • Pahernik S
        • et al.
        A. Prospective Multicenter Phase II Study on Focal Therapy (Hemiablation) of the Prostate with High Intensity Focused Ultrasound.
        J Urol. 2018 Apr; 199: 983-989
        • Orczyk C
        • Barratt D
        • Brew-Graves C
        • et al.
        Prostate Radiofrequency Focal Ablation (ProRAFT) Trial: A Prospective Development Study Evaluating a Bipolar Radiofrequency Device to Treat Prostate Cancer.
        J Urol. 2021 Apr; 205: 1090-1099
        • Andreoiu M
        • Cheng L.
        Multifocal prostate cancer: biologic, prognostic, and therapeutic implications.
        Hum Pathol. 2010 Jun; 41: 781-793
        • Le JD
        • Tan N
        • Shkolyar E
        • et al.
        Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology.
        Eur Urol. 2015 Mar; 67: 569-576
        • Johnson DC
        • Raman SS
        • Mirak SA
        • et al.
        Detection of Individual Prostate Cancer Foci via Multiparametric Magnetic Resonance Imaging.
        Eur Urol. 2019 May; 75: 712-720
        • Arora R
        • Koch MO
        • Eble JN
        • et al.
        Heterogeneity of Gleason grade in multifocal adenocarcinoma of the prostate.
        Cancer. 2004 Jun 1; 100: 2362-2366
        • Wise AM
        • Stamey TA
        • McNeal JE
        • et al.
        Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens.
        Urology. 2002 Aug; 60: 264-269
        • Simma-Chiang V
        • Hom JJ
        • Simko JP
        • et al.
        Increased Prevalence of Unifocal Prostate Cancer in a Contemporary Series of Radical Prostatectomy Specimens: Implications for Focal Ablation.
        J Urol. 2006 Apr 1; 175 (374-374)
        • Ohori M
        • Eastham JA
        • Koh H
        • et al.
        1574: is focal therapy reasonable in patients with early stage prostate cancer (CAP)-an analysis of Radical Prostatectomy (RP) specimens.
        J Urol. 2006 Apr; 175: 507
        • Borges RC
        • Tourinho-Barbosa RR
        • Glina S
        • et al.
        Impact of Focal Versus Whole Gland Ablation for Prostate Cancer on Sexual Function and Urinary Continence.
        J Urol. 2021 Jan; 205: 129-136
        • Patel HD
        • Koehne EL
        • Shea SM
        • et al.
        Risk of prostate cancer for men with prior negative biopsies undergoing magnetic resonance imaging compared with biopsy-naive men: A prospective evaluation of the PLUM cohort.
        Cancer. 2022 Jan 1; 128: 75-84