MP55-03 USING MAGNETIC RESONANCE IMAGING TO DEFINE FOCAL THERAPY TEMPLATES IN PATIENTS WITH INTERMEDIATE-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyCME1 May 2022MP55-03 USING MAGNETIC RESONANCE IMAGING TO DEFINE FOCAL THERAPY TEMPLATES IN PATIENTS WITH INTERMEDIATE-RISK PROSTATE CANCER Alberto Pieretti, Hyunseon Kang, Haesun Choi, Miao Zhang, Brian Chapin, John Ward, Patricia Troncoso, and Justin Gregg Alberto PierettiAlberto Pieretti More articles by this author , Hyunseon KangHyunseon Kang More articles by this author , Haesun ChoiHaesun Choi More articles by this author , Miao ZhangMiao Zhang More articles by this author , Brian ChapinBrian Chapin More articles by this author , John WardJohn Ward More articles by this author , Patricia TroncosoPatricia Troncoso More articles by this author , and Justin GreggJustin Gregg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002634.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy has emerged as a possible treatment option in well-selected patients with localized prostate cancer. However, currently, there is a paucity of data on the long-term oncologic outcomes of focal therapy and on the risk of undertreating patients by using biopsy results and prostate magnetic resonance imaging (MRI) with PI-RADS 3-5 lesions to define focal therapy treatment templates. This study compared focal therapy templates with final pathology results after radical prostatectomy. METHODS: We retrospectively reviewed our institutional database and identified all patients with a biopsy-confirmed MRI lesion with grade group (GG)2 or GG3, and systematic biopsies or other targeted biopsies with <GG2 from 2014-2020; patients with possible extracapsular extension on MRI were excluded. Ablation templates using a 1-cm margin or “hockey stick” were used to assess the elimination of clinically significant prostate cancer. Possible undertreatment was described as “in-field” (on the basis of the MRI lesion), “out-of-field” (a secondary clinically significant prostate cancer that was missed on the template but identified on final pathology), or any failure. RESULTS: Sixty-eight patients met inclusion criteria. The mean tumor size was 1.24 cc on MRI compared to 1.79 cc on final pathology. Using the 1-cm ablation margin, in field failure was present in 31% of patients, with 76% on the craniocaudal axis; out of field failure in 45%; and any failure in 56%. Using the hockey stick template, any failure was present in 26% of patients. Among patients with posterior-predominant lesions, 63% of cases were associated with any failure using the 1-cm margin compared to 26% using the hockey stick template. In anterior-predominant lesions, 48% of cases had any failure using the 1-cm margin compared to 21% using the hockey stick template. CONCLUSIONS: In prostate cancer patients with isolated GG2 or GG3 disease following MRI fusion biopsy, MRI underestimates tumor diameter. 1cm margins have relatively high rates of in-field and out-of-field failure. These data can be used in the planning of prospective focal therapy interventions. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e937 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Pieretti More articles by this author Hyunseon Kang More articles by this author Haesun Choi More articles by this author Miao Zhang More articles by this author Brian Chapin More articles by this author John Ward More articles by this author Patricia Troncoso More articles by this author Justin Gregg More articles by this author Expand All Advertisement PDF DownloadLoading ...