You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy1 Apr 2016MP18-07 APPLICABILITY ANALYSIS OF FOCAL THERAPY TO INTERMEDIATE- AND HIGH-RISK PROSTATE CANCER Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Hiroshi Tanaka, Masaharu Inoue, Masaya Ito, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Yasuhisa Fujii, and Kazunori Kihara Yoh MatsuokaYoh Matsuoka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Hiroshi TanakaHiroshi Tanaka More articles by this author , Masaharu InoueMasaharu Inoue More articles by this author , Masaya ItoMasaya Ito More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2708AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES When focal therapy (FT) is performed with sufficient intensity to eradicate cancer, accurate evaluation for the extent of significant cancer (SC) is essential to avoid undertreatment. By D′Amico risk category of prostate cancer (PC), we assessed the possibility of underdiagnosis by MRI and biopsy for: 1) extra-prostatic extension (EPE) at the ablation field; and 2) SC left in untreated area. We then verified the applicability of quadrant-based regional FT to intermediate- and high-risk PC, compared with low-risk PC. METHODS We enrolled 203 PC patients in clinical stage T≤2 on digital rectal examination who underwent multiparametric MRI, systematic 14-core biopsy, and radical prostatectomy. MRI interpretation followed the Prostate Imaging Reporting and Data System version 2. Cancer distribution was analyzed using a quadrant basis. Anterior and posterior prostatic quadrants were assessed through 4 anterior/lateral cores and 4 posterior/lateral cores, respectively. Additional MRI-targeted sampling was included in the assessment of Gleason score (GS). SC was defined as a lesion with volume ≥0.5 mL and/or GS ≥4+3 and/or EPE. We consider that the absence of EPE is a precondition for FT and that the absence of SC is prerequisite for the untreated area. Each prostate was examined for EPE using MRI, and each quadrant was then assessed for SC using MRI and 4 biopsy cores. RESULTS In total, 35/109/59 men were classified as low-/intermediate-/high-risk cases, respectively. In each risk groups, radiological EPE (rEPE) features on MRI were absent in 31/49/21 men (89/45/36% of each group). Among men without rEPE features in each group, EPE was pathologically absent in 30/47/19 men (97/96/90%) (p = 1.00 and 0.56 in intermediate- and high-risk groups, respectively, vs. the low-risk group). In men without rEPE features, SC was absent in 44/55/23 anterior quadrants (71/56/55%) and 46/55/22 posterior quadrants (74/56/52%). Negative predictive values of the combination of MRI and biopsy for SC were 95/96/100% in anterior quadrants (p = 1.00 and 1.00 in intermediate- and high-risk groups, respectively, vs. the low-risk group) and 94/98/89% in posterior quadrants (p = 0.58 and 0.61). CONCLUSIONS In intermediate- and high-risk PC selected through MRI and biopsy, EPE is absent in 96% and 90% of men, respectively, and SC left in the untreated area is absent in 96-98% and 89-100% of quadrants, respectively, which suggests that FT is an option for intermediate-risk PC as well as low-risk PC. Although carefully-selected high-risk PC might also be a candidate for FT, further study using a larger cohort is needed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e195 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yoh Matsuoka More articles by this author Noboru Numao More articles by this author Kazutaka Saito More articles by this author Hiroshi Tanaka More articles by this author Masaharu Inoue More articles by this author Masaya Ito More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yasuhisa Fujii More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...