Preoperative prediction of multifocal prostate cancer and application of focal therapy: review 2007.

Prostate cancer is a leading malignancy among men. Early prostate cancer is most commonly treated with radical surgery and radiotherapy. In the era of prostate-specific antigen and newly emerging highly specific screening tests, a greater number of men are given a diagnosis earlier in life, and disease is more often confined. Less-invasive treatments, such as focal therapy, are becoming increasingly popular, yielding shorter hospital stays, faster recovery, and fewer complications. Potential drawbacks to focal therapy include the risk of incomplete treatment, which may result from missed cancer foci and inadequate ablation to target tissues. Furthermore, this approach is not universally applicable to all patients--for example, those who have periurethral and extraprostatic extension of the tumor may not benefit from focal treatment. This article reviews the importance of multifocal prostate cancer and the application of focal treatment.

[1]  M W Kattan,et al.  Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. , 1996, The Journal of urology.

[2]  A S Whittemore,et al.  Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer , 1993, Cancer.

[3]  A W Partin,et al.  Prognostic significance of Gleason score 3+4 versus Gleason score 4+3 tumor at radical prostatectomy. , 2000, Urology.

[4]  D. Bostwick,et al.  Proximity of prostate cancer to the urethra: implications for minimally invasive ablative therapies. , 2000, Urology.

[5]  Alan W Partin,et al.  Gleason score 7 prostate cancer on needle biopsy: is the prognostic difference in Gleason scores 4 + 3 and 3 + 4 independent of the number of involved cores? , 2002, The Journal of urology.

[6]  J. Oesterling,et al.  Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. , 1990, The Journal of urology.

[7]  D. Bostwick,et al.  Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4. , 2001, The Journal of urology.

[8]  M. Graefen,et al.  Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. , 2003, European urology.

[9]  A. Jemal,et al.  Cancer Statistics, 2007 , 2007, CA: a cancer journal for clinicians.

[10]  B. Leibovich,et al.  Long-term prognostic significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer: impact on prostate cancer specific survival. , 2006, The Journal of urology.

[11]  P. Albertsen.  PSA and the conservative treatment of early prostate cancer. , 2006, Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica.

[12]  L. Baert,et al.  Impalpable invisible stage T1c prostate cancer: characteristics and clinical relevance in 100 radical prostatectomy specimens--a different view. , 1997, The Journal of urology.

[13]  Liang Cheng,et al.  Does pT2b prostate carcinoma exist? Critical appraisal of the 2002 TNM classification of prostate carcinoma , 2004, Cancer.

[14]  D. Bostwick,et al.  Analysis of risk factors for progression in patients with pathologically confined prostate cancers after radical retropubic prostatectomy. , 1996, The Journal of urology.

[15]  P. Scardino,et al.  Primary Gleason Pattern as a Predictor of Disease Progression in Gleason Score 7 Prostate Cancer: A Multivariate Analysis of 823 Men Treated With Radical Prostatectomy , 2001, The American journal of surgical pathology.

[16]  T. Stamey,et al.  Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate , 1990, Cancer.

[17]  M. Terris,et al.  Detection of clinically significant prostate cancer by transrectal ultrasound-guided systematic biopsies. , 1992, The Journal of urology.

[18]  M. Banerjee,et al.  Gleason score 7 prostate cancer: a heterogeneous entity? Correlation with pathologic parameters and disease-free survival. , 2000, Urology.

[19]  P. Walsh,et al.  Expectant management of nonpalpable prostate cancer with curative intent: preliminary results. , 2002, The Journal of urology.

[20]  J. Epstein,et al.  Does increased needle biopsy sampling of the prostate detect a higher number of potentially insignificant tumors? , 2001, The Journal of urology.

[21]  T. Stamey,et al.  Prostate-Specific Antigen as a Serum Marker for Adenocarcinoma of the Prostate , 1987 .

[22]  D. Bostwick,et al.  The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectomy specimen on an individual basis. , 1995, The Journal of urology.

[23]  E. Bergstralh,et al.  Use of Gleason score, prostate specific antigen, seminal vesicle and margin status to predict biochemical failure after radical prostatectomy. , 2001, The Journal of urology.

[24]  A W Partin,et al.  A neural network predicts progression for men with gleason score 3+4 versus 4+3 tumors after radical prostatectomy. , 2000, Urology.

[25]  T. Stamey,et al.  Stage A versus stage B adenocarcinoma of the prostate: morphological comparison and biological significance. , 1988, The Journal of urology.

[26]  G. Ahn,et al.  Pathologic characteristics of prostatic adenocarcinomas: a mapping analysis of Korean patients , 2003, Prostate Cancer and Prostatic Diseases.

[27]  Liang Cheng,et al.  Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens , 2005, Modern Pathology.

[28]  Susan T. Stewart,et al.  Estimating the risk of long-term erectile, urinary and bowel symptoms resulting from prostate cancer treatment , 2006, Prostate Cancer and Prostatic Diseases.

[29]  A. Kibel,et al.  Minimally invasive approaches to localized prostate carcinoma. , 2006, Hematology/oncology clinics of North America.

[30]  K. Harada,et al.  Prediction of potentially insignificant prostate cancer in men undergoing radical prostatectomy for clinically organ‐confined disease , 2005, International journal of urology : official journal of the Japanese Urological Association.

[31]  D. Bostwick,et al.  Combining prostate specific antigen with cancer and gland volume to predict more reliably pathological stage: the influence of prostate specific antigen cancer density. , 1994, The Journal of urology.

[32]  M. Graefen,et al.  Tumour grade, proliferation, apoptosis, microvessel density, p53, and bcl-2 in prostate cancers: differences between tumours located in the transition zone and in the peripheral zone. , 2002, European urology.

[33]  C. Morash,et al.  Identification of isolated and early prostatic adenocarcinoma in radical prostatectomy specimens with correlation to biopsy cores: clinical and pathogenetic significance. , 2002, Pathology, research and practice.

[34]  H. Ozen,et al.  Individualization of the biopsy protocol according to the prostate gland volume for prostate cancer detection. , 2005, The Journal of urology.

[35]  T. Stamey,et al.  Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer. , 2001, The Journal of urology.

[36]  A. Reith,et al.  Volume-related sequence of tumor distribution pattern in prostate carcinoma: importance of posterior midline crossover in predicting tumor volume, extracapsular extension, and seminal vesicle invasion. , 2005, Croatian medical journal.

[37]  H. Klocker,et al.  Characteristics of prostate cancers detected at low PSA levels , 2004, The Prostate.

[38]  T. Stamey,et al.  Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. , 2003, The Journal of urology.

[39]  Liang Cheng,et al.  Predicting tumor volume in radical prostatectomy specimens from patients with prostate cancer. , 2003, American journal of clinical pathology.

[40]  J. Trachtenberg,et al.  Sexual dysfunction after radical prostatectomy: prevalence, treatments, restricted use of treatments and distress. , 2005, The Journal of urology.

[41]  E. Crawford,et al.  Focal therapy in prostate cancer: future trends , 2005, BJU international.

[42]  M. Marberger,et al.  Predictability and significance of multifocal prostate cancer in the radical prostatectomy specimen. , 1999, Techniques in urology.

[43]  H. Schmid,et al.  Is the percentage of cancer in biopsy cores predictive of extracapsular disease in T1‐T2 prostate carcinoma? , 1996 .

[44]  David G. Bostwick,et al.  Temperature-correlated histo pathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia , 1996 .

[45]  M. Irwin,et al.  Identification of insignificant prostate cancers: analysis of preoperative parameters. , 1994, Urology.

[46]  T. Stamey,et al.  Biological determinants of cancer progression in men with prostate cancer. , 1999, JAMA.

[47]  D. Chan,et al.  Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. , 1998, The Journal of urology.

[48]  T. Uchida,et al.  Long-term impact of conservative management on localized prostate cancer. A twenty-year experience in Japan. , 1993, Urology.

[49]  Hideaki Miyake,et al.  A comparison of the biological features between prostate cancers arising in the transition and peripheral zones , 2005, BJU international.

[50]  T. Stamey,et al.  Multiple cancers in the prostate. Morphologic features of clinically recognized versus incidental tumors , 1992, Cancer.

[51]  E. Crawford,et al.  Minimally Invasive Surgery in Prostate Cancer: Current and Future Perspectives , 2005, Cancer journal.

[52]  T. Stamey,et al.  PATTERNS OF PROGRESSION IN PROSTATE CANCER , 1986, The Lancet.

[53]  P. Walsh,et al.  Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. , 1994, JAMA.

[54]  A. D'Amico,et al.  Impact of the percentage of positive biopsy cores on the further stratification of primary grade 3 and grade 4 Gleason score 7 tumors in radical prostatectomy patients. , 2005, Urology.

[55]  P. Scardino,et al.  Is tumor volume an independent prognostic factor in clinically localized prostate cancer? , 2004, The Journal of urology.

[56]  D. Johnston,et al.  Detailed mapping of prostate carcinoma foci , 2000, Cancer.

[57]  G. Miller,et al.  Morphology of prostate cancer: the effects of multifocality on histological grade, tumor volume and capsule penetration. , 1994, The Journal of urology.

[58]  D. Bostwick,et al.  Staging of prostate cancer. , 1994, Seminars in surgical oncology.

[59]  Liang Cheng,et al.  Perineural invasion in radical prostatectomy specimens: lack of prognostic significance. , 2004, The Journal of urology.

[60]  L. Klotz,et al.  Clinical significance of biopsy-derived primary Gleason score among radical prostatectomy candidates with Gleason 7 tumors. , 2002, Urology.

[61]  R. Sutherland,et al.  Prognostic significance of Gleason pattern in patients with Gleason score 7 prostate carcinoma , 2003, Cancer.