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Factors affecting the selection of eligible candidates for focal therapy for prostate cancer

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Abstract

Purpose

Focal therapy (FT) is a treatment modality for prostate cancer that aims to reduce side effects. However, it remains difficult to select eligible candidates. We herein examined eligibility factors for hemi-ablative FT for prostate cancer.

Methods

We identified 412 patients who were diagnosed with unilateral prostate cancer by biopsy and had undergone radical prostatectomy between 2009 and 2018. Among these patients, 111 underwent MRI before biopsy, had 10–20 core biopsies performed, and did not receive other treatments before surgery. Fifty-seven patients with prostate-specific antigen ≥ 15 ng/mL and biopsy Gleason score (GS) ≥ 4 + 3 were excluded. The remaining 54 patients were evaluated. Both lobes of the prostate were scored using Prostate Imaging Reporting and Data System version 2 on MRI. Ineligible patients for FT were defined as those with ≥ 0.5 mL GS6 or GS ≥ 3 + 4 in the biopsy-negative lobe, ≥ pT3, or lymph node involvement. Selected predictors of eligibility for hemi-ablative FT were analyzed.

Results

Among our cohort of 54 patients, 29 (53.7%) were eligible for hemi-ablative FT. A multivariate analysis identified a PI-RADS score < 3 in the biopsy-negative lobe (p = 0.016) as an independent predictor of eligibility for FT. Thirteen out of 25 ineligible patients had GS ≥ 3 + 4 tumors in the biopsy-negative lobe, half of whom (6/13) also had a PI-RADS score < 3 in the biopsy-negative lobe.

Conclusion

The PI-RADS score in the biopsy-negative lobe may be important in the selection of eligible candidates for FT. The findings of this study will help reduce missed significant prostate cancers and improve FT outcomes.

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Data availability

Data are available upon request to the corresponding author.

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Funding

There are no funding sources. There are no financial disclosures from any authors.

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Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Toshikazu Takeda, Yota Yasumizu, Nobuyuki Tanaka, Kazuhiro Matsumoto, Shinya Morita, Takeo Kosaka, Ryuichi Mizuno, Hiroshi Asanuma & Mototsugu Oya

  2. Department of Radiology, Keio University School of Medicine, Tokyo, Japan

    Keiichi Narita & Masahiro Jinzaki

Authors
  1. Toshikazu Takeda
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  2. Keiichi Narita
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  3. Yota Yasumizu
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  4. Nobuyuki Tanaka
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  5. Kazuhiro Matsumoto
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  6. Shinya Morita
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  7. Takeo Kosaka
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  8. Ryuichi Mizuno
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  9. Hiroshi Asanuma
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  10. Masahiro Jinzaki
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  11. Mototsugu Oya
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Contributions

TT project development, data collection, data analysis, and manuscript writing. KN data collection and data analysis. YY data collection. NT data collection. KM manuscript editing. SM manuscript editing. TK manuscript editing. RM manuscript editing. HA manuscript editing. MJ manuscript editing. MO manuscript editing and supervision.

Corresponding author

Correspondence to Toshikazu Takeda.

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This retrospective study was conducted after receiving approval from the institutional review board.

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Takeda, T., Narita, K., Yasumizu, Y. et al. Factors affecting the selection of eligible candidates for focal therapy for prostate cancer. World J Urol 41, 1821–1827 (2023). https://doi.org/10.1007/s00345-023-04444-6

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  • DOI: https://doi.org/10.1007/s00345-023-04444-6

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