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  • Review Article
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Pathologic basis of focal therapy for early-stage prostate cancer

Nature Reviews Urology volume 6, pages 205–215 (2009)Cite this article

Abstract

The treatment paradigm for small-volume, low-grade unifocal or unilateral prostate cancer is shifting from a radical, whole-gland approach toward organ-sparing, focal ablation. The widely implemented screening program in the US has detected small-volume prostate lesions at early stages of carcinogenesis, which has enabled the shift in treatment paradigm. An image-guided approach to focal therapy has yet to be realized, and is dependent on the development of an imaging modality that detects cancer with high sensitivity and specificity. The future success of focal therapy will depend on adequate prostate sampling at biopsy, along with accurate characterization of the spatial distribution of tumor within the prostate. The pathologic evaluation of radical prostatectomy specimens remains of paramount importance, as this reference standard can validate all preoperative clinical, demographic, laboratory, imaging and prostate biopsy findings.

Key Points

  • Approximately 20–30% of men with prostate cancer have unifocal or unilateral disease and might be candidates for focal therapy

  • The careful study of radical prostatectomy pathology has provided an understanding of tumor volume, grade, focality and location that can be used to select candidates for focal therapy

  • An image-guided approach to focal therapy has yet to be realized, and is dependent on the development of an imaging modality that detects cancer with high sensitivity and specificity

  • In multifocal disease, the index tumor is the presumed main driver of progression, outcome and prognosis; small secondary cancers might be clinically irrelevant if the index lesion is treated

  • The future success of focal therapy will depend on adequate prostate sampling at biopsy, along with accurate characterization of the spatial distribution of tumor within the prostate

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Figure 1: Kaplan–Meier progression-free probability plot by pathologic stage.
Figure 2: The relationship between dynamic contrast-enhanced MRI and histopathology.

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  1. Duke University Medical Center, Durham, NC, USA

    Vladimir Mouraviev, Janice M. Mayes & Thomas J. Polascik

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T. Polascik declared that he has acted as a consultant and received speakers bureau honoraria and grant/research support from Galil Medical. The other authors declared no competing interests.

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Mouraviev, V., Mayes, J. & Polascik, T. Pathologic basis of focal therapy for early-stage prostate cancer. Nat Rev Urol 6, 205–215 (2009). https://doi.org/10.1038/nrurol.2009.29

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