Validation of the current eligibility criteria for focal therapy in men with localized prostate cancer and the role of MRI
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Validation of the current eligibility criteria for focal therapy in men with localized prostate cancer and the role of MRI. / Pompe, Raisa S; Kühn-Thomä, Bieke; Nagaraj, Yamini; Veleva, Valia; Preisser, Felix; Leyh-Bannurah, Sami-Ramzi; Graefen, Markus; Huland, Hartwig; Tilki, Derya; Salomon, Georg.
in: WORLD J UROL, Jahrgang 36, Nr. 5, 05.2018, S. 705-712.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Validation of the current eligibility criteria for focal therapy in men with localized prostate cancer and the role of MRI
AU - Pompe, Raisa S
AU - Kühn-Thomä, Bieke
AU - Nagaraj, Yamini
AU - Veleva, Valia
AU - Preisser, Felix
AU - Leyh-Bannurah, Sami-Ramzi
AU - Graefen, Markus
AU - Huland, Hartwig
AU - Tilki, Derya
AU - Salomon, Georg
PY - 2018/5
Y1 - 2018/5
N2 - PURPOSE: To validate current eligibility criteria for focal therapy (FT) in prostate cancer men undergoing radical prostatectomy (RP) and to assess the role of magnetic resonance imaging (MRI).METHODS: Retrospective analysis of 217 RP patients (2009-2016) with preoperative MRI (almost all in external institutions) and fulfillment of different FT eligibility criteria: unilateral tumor, clinical tumor stage ≤ cT2a, prostate volume ≤ 60 mL and either biopsy Gleason 3 + 3 or ≤ 3 + 4 and PSA ≤ 10 or ≤ 15 ng/mL. Multivariable logistic regression analyses (MVA) assessed the role of MRI to predict the presence of significant contralateral tumor or extracapsular extension (ECE), including seminal vesicle invasion. To quantify model accuracy, Receiver Operating Characteristics-derived area under the curve (AUC) was used.RESULTS: Of 217 patients fulfilling widest biopsy criteria and 113 fulfilling additional MRI criteria, 64 (29.7%) and 37 (32.7%) remained eligible for FT according to histopathological results. In MVA, fulfillment of MRI criteria reached independent predictor status for prediction of contralateral tumor but not for ECE. Addition of MRI resulted in AUC gain (57.5-64.6%). Sensitivity, specificity, PPV and NPV for MRI to predict contralateral tumor were: 41.8, 71.6, 70.9 and 42.6%, respectively. Virtually the same results were recorded for Gleason 3 + 3 and/or PSA ≤ 10 ng/mL.CONCLUSIONS: Patient eligibility criteria for FT using biopsy criteria remained insufficient with respect to contralateral tumor disease. Although, MRI improves accuracy, it cannot safely exclude or minimize chance of significant cancer on contralateral prostate side. To date, stricter eligibility criteria are needed to provide more diagnostic reliability.
AB - PURPOSE: To validate current eligibility criteria for focal therapy (FT) in prostate cancer men undergoing radical prostatectomy (RP) and to assess the role of magnetic resonance imaging (MRI).METHODS: Retrospective analysis of 217 RP patients (2009-2016) with preoperative MRI (almost all in external institutions) and fulfillment of different FT eligibility criteria: unilateral tumor, clinical tumor stage ≤ cT2a, prostate volume ≤ 60 mL and either biopsy Gleason 3 + 3 or ≤ 3 + 4 and PSA ≤ 10 or ≤ 15 ng/mL. Multivariable logistic regression analyses (MVA) assessed the role of MRI to predict the presence of significant contralateral tumor or extracapsular extension (ECE), including seminal vesicle invasion. To quantify model accuracy, Receiver Operating Characteristics-derived area under the curve (AUC) was used.RESULTS: Of 217 patients fulfilling widest biopsy criteria and 113 fulfilling additional MRI criteria, 64 (29.7%) and 37 (32.7%) remained eligible for FT according to histopathological results. In MVA, fulfillment of MRI criteria reached independent predictor status for prediction of contralateral tumor but not for ECE. Addition of MRI resulted in AUC gain (57.5-64.6%). Sensitivity, specificity, PPV and NPV for MRI to predict contralateral tumor were: 41.8, 71.6, 70.9 and 42.6%, respectively. Virtually the same results were recorded for Gleason 3 + 3 and/or PSA ≤ 10 ng/mL.CONCLUSIONS: Patient eligibility criteria for FT using biopsy criteria remained insufficient with respect to contralateral tumor disease. Although, MRI improves accuracy, it cannot safely exclude or minimize chance of significant cancer on contralateral prostate side. To date, stricter eligibility criteria are needed to provide more diagnostic reliability.
KW - Ablation Techniques
KW - Aged
KW - Biopsy
KW - Dimensional Measurement Accuracy
KW - Eligibility Determination
KW - Germany
KW - Humans
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Neoplasm Staging
KW - Patient Selection
KW - Prostate
KW - Prostate-Specific Antigen
KW - Prostatectomy
KW - Prostatic Neoplasms
KW - Reproducibility of Results
KW - Retrospective Studies
KW - Journal Article
U2 - 10.1007/s00345-018-2238-2
DO - 10.1007/s00345-018-2238-2
M3 - SCORING: Journal article
C2 - 29492583
VL - 36
SP - 705
EP - 712
JO - WORLD J UROL
JF - WORLD J UROL
SN - 0724-4983
IS - 5
ER -