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Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy.

Publication ,  Journal Article
Polascik, TJ; Mayes, JM; Schroeck, FR; Sun, L; Madden, JF; Moul, JW; Mouraviev, V
Published in: Cancer
May 15, 2009

BACKGROUND: The application of focal therapy for low-risk prostate cancer (PCa) depended on appropriate patient selection. No definitive criteria existed to characterize patients who may potentially benefit from an organ-sparing approach. We evaluated pretreatment clinical parameters that may predict unilateral PCa amenable to hemigland thermoablation. METHODS: In total, 538 patients with complete data from the Duke Prostate Center (DPC) Outcomes database with low- to low-intermediate-risk PCa (prostate-specific antigen<10 ng/mL, biopsy Gleason score < or =7, and clinical stage T1c-T2b) treated with radical prostatectomy (RP) were included in the dataset. Patients underwent diagnostic prostate biopsy (PBx) at Duke or community hospitals from 1996 to 2006. Clinical and biopsy parameters were assessed as to the ability to predict PCa unilaterality verified by RP pathology. RESULTS: The strongest predictor of pathologic unilaterality was PBx unilaterality. The sensitivity and specificity for biopsy unilaterality to predict pathologic unilaterality was 88.4% and 34%, with a positive predictive value of 28% and a negative predictive value of 91%. PBx unilaterality (odds ratio [OR] = 3.88; 95% confidence interval [CI], 2.14-7.05; P < .0005) and negative family history of PCa (OR = 1.83; 95% CI, 1.09-3.05; P = .21) was associated with a higher probability of unilateral disease by multivariate regression. CONCLUSIONS: Two pretreatment clinical variables were significantly predictive of unilateral PCa: negative family history of PCa and PBx unilaterality. These variables may be used to select men with low- to low-moderate-risk PCa for hemiablation. Further work is necessary to decrease the false-negative and false-positive rates associated with PBx to improve predictability for PCa laterality.

Duke Scholars

Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

May 15, 2009

Volume

115

Issue

10

Start / End Page

2104 / 2110

Location

United States

Related Subject Headings

  • Prostatic Neoplasms
  • Prostatectomy
  • Patient Selection
  • Oncology & Carcinogenesis
  • Male
  • Humans
  • Family Health
  • Biopsy
  • Ablation Techniques
  • 4206 Public health
 

Citation

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Polascik, T. J., Mayes, J. M., Schroeck, F. R., Sun, L., Madden, J. F., Moul, J. W., & Mouraviev, V. (2009). Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy. Cancer, 115(10), 2104–2110. https://doi.org/10.1002/cncr.24258
Polascik, Thomas J., Janice M. Mayes, Florian R. Schroeck, Leon Sun, John F. Madden, Judd W. Moul, and Vladimir Mouraviev. “Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy.Cancer 115, no. 10 (May 15, 2009): 2104–10. https://doi.org/10.1002/cncr.24258.
Polascik TJ, Mayes JM, Schroeck FR, Sun L, Madden JF, Moul JW, et al. Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy. Cancer. 2009 May 15;115(10):2104–10.
Polascik, Thomas J., et al. “Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy.Cancer, vol. 115, no. 10, May 2009, pp. 2104–10. Pubmed, doi:10.1002/cncr.24258.
Polascik TJ, Mayes JM, Schroeck FR, Sun L, Madden JF, Moul JW, Mouraviev V. Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy. Cancer. 2009 May 15;115(10):2104–2110.
Journal cover image

Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

May 15, 2009

Volume

115

Issue

10

Start / End Page

2104 / 2110

Location

United States

Related Subject Headings

  • Prostatic Neoplasms
  • Prostatectomy
  • Patient Selection
  • Oncology & Carcinogenesis
  • Male
  • Humans
  • Family Health
  • Biopsy
  • Ablation Techniques
  • 4206 Public health