MP30-08 PERINEURAL INVASION PREDICTS FAILURE OF MR/US FUSION BIOPSY-BASED SELECTION CRITERIA FOR HEMIABLATIVE FOCAL THERAPY IN PATIENTS WITH INTERMEDIATE-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I1 Apr 2018MP30-08 PERINEURAL INVASION PREDICTS FAILURE OF MR/US FUSION BIOPSY-BASED SELECTION CRITERIA FOR HEMIABLATIVE FOCAL THERAPY IN PATIENTS WITH INTERMEDIATE-RISK PROSTATE CANCER Prabhakar Mithal, Matthew Truong, Diane Lu, Gary Hollenberg, Eric Weinberg, Hiroshi Miyamoto, and Thomas Frye Prabhakar MithalPrabhakar Mithal More articles by this author , Matthew TruongMatthew Truong More articles by this author , Diane LuDiane Lu More articles by this author , Gary HollenbergGary Hollenberg More articles by this author , Eric WeinbergEric Weinberg More articles by this author , Hiroshi MiyamotoHiroshi Miyamoto More articles by this author , and Thomas FryeThomas Frye More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.949AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES MR/US fusion targeted biopsy is frequently used to guide patient selection for focal therapy in prostate cancer (PCa). However, the optimal selection criteria for focal therapy are not well understood. In patients selected as theoretical candidates for hemiablation based on unilateral intermediate risk disease found on MR/US fusion biopsy, we examined factors that predict failure of hemiablative therapy. METHODS A retrospectively maintained single institution multiparametric MRI (mpMRI) database (n = 1,001) was queried to identify 290 patients who underwent MR/US fusion targeted biopsy (TB) with concurrent systematic biopsy (SB) from December 1, 2014 to June 1, 2017. Clinical, pathological, and imaging variables were assessed (Table 1) to determine which patients met selection criteria for hemiablation, defined as unilateral intermediate risk PCa per NCCN criteria (Grade Group (GG) 2 or 3 with PSA <20). Predictors of selection criteria failure were then assessed in patients who subsequently underwent radical prostatectomy (RP). All RP specimens were re-reviewed by a genitourinary pathologist. Hemiablation failure was defined as presence of GG >=2 on the contralateral (untreated) side, or the presence of high risk disease (any GG>=4 or extraprostatic extension (EPE) at RP. RESULTS Of the 290 patients who underwent fusion biopsy, 78 patients met the theoretical selection criteria for hemiablation. Among patients eligible, 27 underwent RP. Hemiablation failure was observed in 18/27 (67%) of patients, of which 12 had EPE and 14 had bilateral GG >=2. The positive predictive value of combined TB and SB for predicting successful hemiablation was 0.33. The only statistically significant factor identifiable at the time of biopsy associated with hemiablation failure was perineural invasion (PNI) on SB (p=0.016, Table 1). Overall, 10/11 (91%) of patients who had PNI on SB had hemiablation failure. CONCLUSIONS In an analysis of RP specimens, PNI on SB was the only predictor of hemiablation failure in patients with unilateral intermediate risk PCa at the time of MR/US fusion targeted biopsy with concurrent SB. PNI may be considered as an exclusion criteria for focal therapy in prospective clinical trials. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e377 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Prabhakar Mithal More articles by this author Matthew Truong More articles by this author Diane Lu More articles by this author Gary Hollenberg More articles by this author Eric Weinberg More articles by this author Hiroshi Miyamoto More articles by this author Thomas Frye More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...