The proportion of potential candidates for focal therapy in localized prostate cancer in a real-life cohort and their final pathologic results.

Abstract

To determine the proportion of patients who would have been eligible for focal therapy (FT) in a population of patients who underwent prostatectomies; additionally, to assess the risk of having underestimated disease on the surgical specimen by using consensus selection criteria. We retrospectively analyzed data from 446 patients who underwent radical prostatectomy between 2016 and 2018. Patients suitable for FT had unifocal significant prostate cancer on MRI, as well as on pathological data from targeted and systematic biopsies. Inclusion criteria were defined by the 2014 consensus conference, PSA<15ng/mL, tumor stage T1c-T2a and Gleason score 3+3 or 3+4 on biopsies. Disease was considered to be underestimated on postoperative data in the presence of extraprostatic invasion, a high Gleason score (≥4+4) and significant multifocality defined by secondary foci of Gleason 6 (3+3)>5mm or Gleason 7 (3+4). In our cohort of 446 patients, 97 patients met the inclusion criteria, and 27 patients (27.8%) were eligible for focal therapy. Among the eligible patients, 4 patients (14.8%) had pT3, and no patient had significant multifocality or a Gleason score of 8 (4+4) on the surgical specimen. In the era of pre-biopsy MRI, there could be a significant proportion of patients who could benefit from focal therapy among patients currently undergoing radical prostatectomy. The 2014 consensus conference eligibility criteria could effectively predict the presence of extraprostatic invasion and safely select patients for FT.