Predicting Unilateral Prostate Cancer Based On Biopsy Features: Implications For Focal Ablative Therapy Results From The SEARCH Database

Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Urology / Nephrology;  Clinical Trials / Drug Trials
Article Date: 28 Oct 2007 - 0:00 PDT

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UroToday.com- New focal ablative therapies that just treat areas of the prostate containing tumor are being reported. However, according to a report in the October, 2007 issue of the Journal of Urology from the SEARCH Database, unilateral prostate cancer (CaP) can not be identified preoperatively by biopsy criteria.

The SEARCH database is comprised of a multicenter Veterans Affairs dataset of patients with CaP. The authors identified 261 men with clinical stage T1c or T2 CaP, PSA <10ng/ml, Gleason score <6, and 1 or 2 ipsilateral positive cores on at least sextant biopsy.

Mean patients age was 60.6 years and 55% were white and 38% were black. Median PSA was 5.5ng/ml and the median number of biopsy cores obtained was 8. Only 93 of the 261 men (35%) had unilateral disease on examination of the radical prostatectomy specimen. This means about two-thirds of patients with unilateral low risk CaP on biopsy had bilateral CaP on pathological examination of the surgical specimen. Age did not predict for unilateral vs. bilateral CaP. In multivariable analysis no preoperative clinical factors were predictive of unilateral vs. bilateral disease. This suggests that focal therapies can not be adequately planned upon the assumption that only unilateral disease exists in most patients. The clinical implications for focal therapies, however, are not know from this data but the suggestion is that complete tumor ablation will not be achieved.

Scales CD, Presti JC, Kane CJ, Terris MK, Aronson WJ, Amling CL, Freedland SJ for the SEARCH Database Study Group

J Urol. ePub: August 15, 2007
doi:10.1016/j.juro.2007.05.151

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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