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Clinical Research

Prediction of prostate cancer to urethra distance by a pretreatment nomogram: urethral thermoprotection implication in cryoablation

Prostate Cancer and Prostatic Diseases volume 16, pages 372–375 (2013)Cite this article

Subjects

Abstract

Introduction:

Cryoablation is a treatment option for prostate cancer (PCa) patients. A urethral warming catheter is placed to protect the prostatic urethra from cryo-injury. Thus tissue within certain depth beneath the urethral mucosa, including PCa in that zone, is not cryoablated. Preoperative predictors of PCa-to-urethra distance are important for urologists and patients to decide if undergoing cryoablation.

Methods:

A total of 267 consecutive radical prostatectomy specimens were reviewed by a pathologist and the shortest PCa-to-urethra distance was recorded as 0 (PCa at urethra), 0.1–1 mm, 1.1–2 mm, 2.1–3 mm, 3.1–4 mm, 4.1–5 mm and >5 mm. Preoperative serum PSA (iPSA) and prostate biopsy (Bx) parameters such as highest Bx Gleason score (BxGS), number of positive cores, highest percentage of PCa/cores, bilateral disease, perineural invasion (PNI) and PCa location were also recorded. The PCa-to-urethra distance subdivided into two (⩽3 and >3 mm) and all seven categories was correlated with iPSA and Bx parameters. Logistic and linear regression were used to analyze the data.

Results:

Patients’ median age and iPSA were 59 years and 5.28 ng ml−1, respectively. PCa-to-urethra distance was <5 mm in 163 (61%) patients, ⩽3 mm in 48% of patients. Significant univariate associations were found between shorter PCa-to-urethra distance and increasing iPSA (P<0.0001), BxGS (P=0.0016), number of positive cores (P< 0.0001), highest percentage of PCa/cores (P< 0.0001), bilateral disease (P=0.0003), PNI (P=0.01) and PCa detected in biopsies from apex (P< 0.0001), base (P=0.001) and base/medial base (P= 0.0006). In multivariate analysis, the iPSA (log), highest percentage of PCa/cores and PCa detected in the apex were significantly associated (P<0.0001) with both versions of PCa-to-urethra distance.

Conclusions:

Increasing iPSA, highest percentage of PCa/cores and PCa detected in the apex were associated with a shorter PCa-to-urethra distance. Inclusion of these preoperative parameters in a nomogram will help estimating the PCa-to-urethra distance and identifying better candidates for cryoablation.

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References

  1. Abern MR, Tsivian M, Polascik TJ . Focal therapy of prostate cancer: evidence-based analysis for modern selection criteria. Curr Urol Rep 2012; 13: 160–169.

    Article  Google Scholar 

  2. Nguyen CT, Jones JS . Focal therapy in the management of localized prostate cancer. BJU Int 2011; 107: 1362–1368.

    Article  Google Scholar 

  3. Nomura T, Mimata H . Focal therapy in the management of prostate cancer: an emerging approach for localized prostate cancer. Advances in urology 2012; 2012, 3347714.

  4. Polascik TJ, Mouraviev V . Focal therapy for prostate cancer. Curr Opin Urol 2008; 18: 269–274.

    Article  Google Scholar 

  5. Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J . The "male lumpectomy": focal therapy for prostate cancer using cryoablation results in 48 patients with at least 2-year follow-up. Urol Oncol 2008; 26: 500–505.

    Article  Google Scholar 

  6. Onik GM, Cohen JK, Reyes GD, Rubinsky B, Chang Z, Baust J . Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer 1993; 72: 1291–1299.

    Article  CAS  Google Scholar 

  7. Lian H, Guo H, Gan W, Li X, Yan X, Wang W et al. Cryosurgery as primary treatment for localized prostate cancer. Int Urol Nephrol 2011; 43: 1089–1094.

    Article  Google Scholar 

  8. Mouraviev V, Spiess PE, Jones JS . Salvage cryoablation for locally recurrent prostate cancer following primary radiotherapy. Eur Urol 2012; 61: 1204–1211.

    Article  Google Scholar 

  9. Bahn DK, Lee F, Badalament R, Kumar A, Greski J, Chernick M . Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer. Urology 2002; 60: 3–11.

    Article  Google Scholar 

  10. Cytron S, Paz A, Kravchick S, Shumalinski D, Moore J . Active rectal wall protection using direct transperineal cryo-needles for histologically proven prostate adenocarcinomas. Eur Urol 2003; 44: 315–320.

    Article  Google Scholar 

  11. Nguyen CT, Jones JS . Focal therapy in the management of localized prostate cancer. BJU Int 2011; 107: 1362–1368.

    Article  Google Scholar 

  12. Saliken JC, Donnelly BJ, Rewcastle JC . The evolution and state of modern technology for prostate cryosurgery. Urology 2002; 60: 26–33.

    Article  Google Scholar 

  13. Perrotte P, Litwin MS, McGuire EJ, Scott SM, von Eschenbach AC, Pisters LL . Quality of life after salvage cryotherapy: the impact of treatment parameters. J Urol 1999; 162: 398–402.

    Article  CAS  Google Scholar 

  14. Levy D, Avallone A, Jones JS . Current state of urological cryosurgery: prostate and kidney. BJU Int 2010; 105: 590–600.

    Article  Google Scholar 

  15. Mouraviev V, Johansen TE, Polascik TJ . Contemporary results of focal therapy for prostate cancer using cryoablation. J Endourol 2010; 24: 827–834.

    Article  Google Scholar 

  16. Rabin Y, Stahovich T . The thermal effect of urethral warming during cryosurgery. Cryo letters 2002; 23: 361–374.

    PubMed  Google Scholar 

  17. Falzarano SM, Navas M, Simmerman K, Klein EA, Rubin MA, Zhou M et al. ERG rearrangement is present in a subset of transition zone prostatic tumors. Mod Pathol 2010; 23: 1499–1506.

    Article  Google Scholar 

  18. Renshaw AA, Chang H, D'Amico AV . Estimation of tumor volume in radical prostatectomy specimens in routine clinical practice. Am J Clin Pathol 1997; 107: 704–708.

    Article  CAS  Google Scholar 

  19. Jain AK, Ennis RD . Focal therapy, differential therapy, and radiation treatment for prostate cancer. Adv Urol 2012; 2012: 573193.

    Article  Google Scholar 

  20. Borofsky MS, Ito T, Rosenkrantz AB, Taneja SS . Focal therapy for prostate cancer - where are we in 2011? Ther Adv Urol 2011; 3 4: 183–192.

    Article  CAS  Google Scholar 

  21. Rukstalis DB, Goldknopf JL, Crowley EM, Garcia FU . Prostate cryoablation: a scientific rationale for future modifications. Urology 2002; 60: 19–25.

    Article  Google Scholar 

  22. Baissalov R, Sandison GA, Donnelly BJ, Saliken JC, McKinnon JG, Muldrew K et al. A semi-empirical treatment planning model for optimization of multiprobe cryosurgery. Phys Med Biol 2000; 45: 1085–1098.

    Article  CAS  Google Scholar 

  23. Larson TR, Bostwick DG, Corica A . Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia. Urology 1996; 47: 463–469.

    Article  CAS  Google Scholar 

  24. Leibovich BC, Blute ML, Bostwick DG, Wilson TM, Pisansky TM, Davis BJ et al. Proximity of prostate cancer to the urethra: implications for minimally invasive ablative therapies. Urology 2000; 56: 726–729.

    Article  CAS  Google Scholar 

  25. Bostwick DG, Gould VE, Qian J, Susani M, Marberger M . Prostate cancer detected by uPM3: radical prostatectomy findings. Mod Pathol 2006; 19: 630–633.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors thank Brian Wells, MD, PhD, from the Quantitative Health Sciences Department at the Cleveland Clinic for his help in the development of the nomogram.

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Authors and Affiliations

  1. Pathology and Laboratory Medicine Institute, Cleveland, OH, USA

    M M Padilha, K Streator Smith & C Magi-Galluzzi

  2. Glickman Urological and Kidney Institute, Cleveland, OH, USA

    J Stephen Jones & C Magi-Galluzzi

  3. Department of Pathology, New York University Langone Medical Center, New York, NY, USA

    M Zhou

  4. Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    E Walker

Authors
  1. M M Padilha
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  2. J Stephen Jones
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Correspondence to C Magi-Galluzzi.

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Competing interests

J. Stephen Jones is a consultant and advisory board member for Health Tronics. Mariana M. Padilha, Karen Streator Smith, Ming Zhou, Esteban Walker and Cristina Magi-Galluzzi declare no conflicts of interest.

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Padilha, M., Stephen Jones, J., Streator Smith, K. et al. Prediction of prostate cancer to urethra distance by a pretreatment nomogram: urethral thermoprotection implication in cryoablation. Prostate Cancer Prostatic Dis 16, 372–375 (2013). https://doi.org/10.1038/pcan.2013.32

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