Introduction: To determine whether unilateral prostate cancer diagnosed at 12-core prostate biopsy harbours relevant prostate cancer foci in contralateral lobe in cases eligible for hemiablative focal therapy. Material and Methods: We analysed 112 radical prostatectomies of unilateral Gleason 6/7 prostate cancer based on prostate biopsy information. The presence of significant prostate cancer foci and/or the index lesion in the contralateral lobe is described. A subanalysis is performed in cases of Gleason score 6 and in cases of very-low-risk prostate cancer. Results: Contralateral prostate cancer was present in 69.6% of cases, fulfilling significant prostate cancer criteria in 33% and being the index lesion in 32%. No significant differences were found when analysing the Gleason 6 group (73% contralateral prostate cancer, 34% significant prostate cancer and 35% index lesion) or the very-low-risk prostate cancer group (80% contralateral prostate cancer, 29% significant prostate cancer and 45% index lesion). Conclusions: The assumption of unilateral prostate cancer based on 12-core template prostate biopsy information is unreliable. In about one third of the cases, there will be focus of significant prostate cancer or the index lesion in the contralateral lobe. This information should be taken into account when hemiablative focal therapies are considered.

Keywords:
Biopsy, Needle, Prostate cancer, Prostatectomy, Tumor burden, pathology, Staging
1.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ: Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-249.
2.
Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J: The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol 2004;172:1297-1301.
3.
van den Bos W, Muller BG, Ahmed H, et al: Focal therapy in prostate cancer: international multidisciplinary consensus on trial design. Eur Urol 2014;65:1078-1083.
4.
Ahmed HU: The index lesion and the origin of prostate cancer. N Engl J Med 2009;361:1704-1706.
5.
Tsivian M, Abern MR, Polascik TJ: Evolution of the concept of focal therapy for prostate cancer. Oncology (Williston Park) 2013;27:64-68, 70; discussion 70.
6.
Algaba F, Montironi R: Impact of prostate cancer multifocality on its biology and treatment. J Endourol 2010;24:799-804.
7.
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.
8.
Chen ME, Johnston DA, Tang K, Babaian RJ, Troncoso P: Detailed mapping of prostate carcinoma foci: biopsy strategy implications. Cancer 2000;89:1800-1809.
9.
Briganti A, Tutolo M, Suardi N, et al: There is no way to identify patients who will harbor small, unilateral prostate cancer at final pathology. Implications for focal therapies. Prostate 2012;72:925-930.
10.
Epstein JI, Allsbrook WC Jr, Amin MB, et al: The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005;29:1228-1242.
11.
Mohler J, Bahnson RR, Boston B, et al: NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw 2010;8:162-200.
12.
Mouraviev V, Mayes JM, Sun L, Madden JF, Moul JW, Polascik TJ: Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer. Cancer 2007;110:906-910.
13.
Polascik TJ, Mayes JM, Schroeck FR, et al: Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy. Cancer 2009;115:2104-2110.
14.
Lambert EH, Bolte K, Masson P, Katz AE: Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology 2007;69:1117-1120.
15.
Bahn D, de Castro Abreu AL, Gill IS, et al: Focal cryotherapy for clinically unilateral, low-intermediate risk prostate cancer in 73 men with a median follow-up of 3.7 years. Eur Urol 2012;62:55-63.
16.
Ahmed HU, Hindley RG, Dickinson L, et al: Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol 2012;13:622-632.
17.
El Fegoun AB, Barret E, Prapotnich D, et al: Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly. A feasibility study with 10 years follow-up. Int Braz J Urol 2011;37:213-219; discussion 220-222.
18.
Sinnott M, Falzarano SM, Hernandez AV, et al: Discrepancy in prostate cancer localization between biopsy and prostatectomy specimens in patients with unilateral positive biopsy: implications for focal therapy. Prostate 2012;72:1179-1186.
19.
Ward JF, Nakanishi H, Pisters L, Babaian RJ, Troncoso P: Cancer ablation with regional templates applied to prostatectomy specimens from men who were eligible for focal therapy. BJU Int 2009;104:490-497.
20.
Sfoungaristos S, Perimenis P: Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates. Can Urol Assoc J 2013;7:E82-E87.
21.
Scales CD Jr, Presti JC Jr, Kane CJ, et al: Predicting unilateral prostate cancer based on biopsy features: implications for focal ablative therapy - results from the SEARCH database. J Urol 2007;178:1249-1252.
22.
Gallina A, Maccagnano C, Suardi N, et al: Unilateral positive biopsies in low risk prostate cancer patients diagnosed with extended transrectal ultrasound-guided biopsy schemes do not predict unilateral prostate cancer at radical prostatectomy. BJU Int 2012;110:E64-E68.
23.
Abdollah F, Scattoni V, Raber M, et al: The role of transrectal saturation biopsy in tumour localization: pathological correlation after retropubic radical prostatectomy and implication for focal ablative therapy. BJU Int 2011;108:366-371.
24.
Ahmed HU, Akin O, Coleman JA, et al: Transatlantic consensus group on active surveillance and focal therapy for prostate cancer. BJU Int 2012;109:1636-1647.
25.
Junker D, Schäfer G, Heidegger I, et al: Multiparametric magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy of the prostate: preliminary results of a prospective single-centre study. Urol Int 2015, Epub ahead of print.
26.
Kaufmann S, Kruck S, Kramer U, et al: Direct comparison of targeted MRI-guided biopsy with systematic transrectal ultrasound-guided biopsy in patients with previous negative prostate biopsies. Urol Int 2014, Epub ahead of print.
27.
Hoeks CM, Barentsz JO, Hambrock T, et al: Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 2011;261:46-66.
28.
Rosenkrantz AB, Deng FM, Kim S, et al: Prostate cancer: multiparametric MRI for index lesion localization - a multiple-reader study. AJR Am J Roentgenol 2012;199:830-837.
29.
Vargas HA, Akin O, Franiel T, et al: Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness. Radiology 2011;259:775-784.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.