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The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study

Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We colle...

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Autores principales: Paladini, Alessio, Cochetti, Giovanni, Colau, Alexandre, Mouton, Martin, Ciarletti, Sara, Felici, Graziano, Maiolino, Giuseppe, Balzarini, Federica, Sèbe, Philippe, Mearini, Ettore
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9600719/
https://www.ncbi.nlm.nih.gov/pubmed/36290815
http://dx.doi.org/10.3390/curroncol29100538
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author Paladini, Alessio
Cochetti, Giovanni
Colau, Alexandre
Mouton, Martin
Ciarletti, Sara
Felici, Graziano
Maiolino, Giuseppe
Balzarini, Federica
Sèbe, Philippe
Mearini, Ettore
author_facet Paladini, Alessio
Cochetti, Giovanni
Colau, Alexandre
Mouton, Martin
Ciarletti, Sara
Felici, Graziano
Maiolino, Giuseppe
Balzarini, Federica
Sèbe, Philippe
Mearini, Ettore
author_sort Paladini, Alessio
collection PubMed
description Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason Score (GS) of ≤7, ≤cT2a, PSA of ≤10 ng/mL, and GS 6 on a random biopsy with ≤2 positive foci out of 12. Potential oncological safety of FT was defined as the respect of clinicopathological inclusion criteria on histology specimens, no extracapsular extension, and no biochemical, local, or metastatic recurrence within 12 months. To predict FT failure, we performed uni- and multivariate logistic regression. Sixty-seven patients were enrolled. The MRI index lesion median size was 11 mm; target lesions were ISUP grade 1 in 27 patients and ISUP grade 2 in 40. Potential FT failure occurred in 32 patients, and only the PSA value resulted as a predictive parameter (p < 0.05). The main issue for FT is patient selection, mainly because of multifocal csPCa foci. Nevertheless, FT could represent a therapeutic alternative for highly selected low-risk PCa patients.
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spelling pubmed-96007192022-10-27 The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study Paladini, Alessio Cochetti, Giovanni Colau, Alexandre Mouton, Martin Ciarletti, Sara Felici, Graziano Maiolino, Giuseppe Balzarini, Federica Sèbe, Philippe Mearini, Ettore Curr Oncol Article Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason Score (GS) of ≤7, ≤cT2a, PSA of ≤10 ng/mL, and GS 6 on a random biopsy with ≤2 positive foci out of 12. Potential oncological safety of FT was defined as the respect of clinicopathological inclusion criteria on histology specimens, no extracapsular extension, and no biochemical, local, or metastatic recurrence within 12 months. To predict FT failure, we performed uni- and multivariate logistic regression. Sixty-seven patients were enrolled. The MRI index lesion median size was 11 mm; target lesions were ISUP grade 1 in 27 patients and ISUP grade 2 in 40. Potential FT failure occurred in 32 patients, and only the PSA value resulted as a predictive parameter (p < 0.05). The main issue for FT is patient selection, mainly because of multifocal csPCa foci. Nevertheless, FT could represent a therapeutic alternative for highly selected low-risk PCa patients. MDPI 2022-09-22 /pmc/articles/PMC9600719/ /pubmed/36290815 http://dx.doi.org/10.3390/curroncol29100538 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Paladini, Alessio
Cochetti, Giovanni
Colau, Alexandre
Mouton, Martin
Ciarletti, Sara
Felici, Graziano
Maiolino, Giuseppe
Balzarini, Federica
Sèbe, Philippe
Mearini, Ettore
The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study
title The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study
title_full The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study
title_fullStr The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study
title_full_unstemmed The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study
title_short The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study
title_sort challenges of patient selection for prostate cancer focal therapy: a retrospective observational multicentre study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9600719/
https://www.ncbi.nlm.nih.gov/pubmed/36290815
http://dx.doi.org/10.3390/curroncol29100538
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