Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Research

Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy

Abstract

It has been suggested that in multifocal prostate cancer (PCa), focal therapy to the largest (index) lesion is sufficient, because secondary non-index lesions are unlikely to contribute to disease progression. In this study, the role of PCa focality in selecting men for focal therapy was evaluated. A histopathological analysis of the index and non-index lesions of 100 consecutive radical prostatectomy specimens was carried out. Cases that would have been suitable for focal ablation were also evaluated. Tumours were more often multifocal (78%) and bilateral (86%). In total, 270 tumour foci were identified. In multifocal disease, tumour volume, Gleason score and pathological stage were almost invariably defined by the index lesion of the specimen; among the 170 satellite foci, 148 (87%) were <0.5 cm3 and 169 (99.4%) had Gleason score 6. Using the defined criteria, 51% of men in this series would have been considered suitable for focal ablation of the index lesion. Histological features of poor prognosis in the prostate are associated with the index lesion. There is a high proportion of patients who may be suitable for focal therapy, and clinical trials of index lesion ablation should be considered as part of this therapeutic strategy.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Similar content being viewed by others

References

  1. Ahmed HU, Pendse D, Illing R, Allen C, van der Meulen JH, Emberton M . Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol 2007; 4: 632–642.

    Article  PubMed  Google Scholar 

  2. Barqawi AB, Crawford ED . The current use and future trends of focal surgical therapy in the management of localized prostate cancer. Cancer J 2007; 13: 313–317.

    Article  PubMed  Google Scholar 

  3. Bostwick DG, Waters DJ, Farley ER, Meiers I, Rukstalis D, Cavanaugh WA et al. Group consensus reports from the Consensus Conference on Focal Treatment of Prostatic Carcinoma, Celebration, Florida, February 24, 2006. Urology 2007; 70 (6 Suppl): 42–44.

    Article  PubMed  Google Scholar 

  4. Djavan B, Susani M, Bursa B, Basharkhah A, Simak R, Marberger M . Predictability and significance of multifocal prostate cancer in the radical prostatectomy specimen. Tech Urol 1999; 5: 139–142.

    Article  CAS  PubMed  Google Scholar 

  5. Quintal MM, Magna LA, Guimaraes MS, Ruano T, Ferreira U, Billis A . Prostate cancer pathologic stage pT2b (2002 TNM staging system): does it exist? Int Braz J Urol 2006; 32: 43–47.

    Article  PubMed  Google Scholar 

  6. Langenstroer P, Carroll P, Thrasher JB . Clinical and pathological characteristics of unstageable prostate cancer: analysis of the CaPSURE database. J Urol 2005; 174: 118–120.

    Article  PubMed  Google Scholar 

  7. Gregori A, Vieweg J, Dahm P, Paulson DF . Comparison of ultrasound-guided biopsies and prostatectomy specimens: predictive accuracy of Gleason score and tumor site. Urol Int 2001; 66: 66–71.

    Article  CAS  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. Chen ME, Johnston DA, Tang K, Babaian RJ, Troncoso P . Detailed mapping of prostate carcinoma foci: biopsy strategy implications. Cancer 2000; 89: 1800–1809.

    Article  CAS  PubMed  Google Scholar 

  10. Miller GJ, Cygan JM . Morphology of prostate cancer: the effects of multifocality on histological grade, tumor volume and capsule penetration. J Urol 1994; 152 (5 Pt 2): 1709–1713.

    Article  CAS  PubMed  Google Scholar 

  11. Simma-Chiang V, Horn JJ, Simko JP, Chan JM, Carroll PR . Increased prevalence of unifocal prostate cancer in a contemporary series of radical prostatectomy specimens: implications for focal ablation. J Urol 2006; 175: 1163.

    Article  Google Scholar 

  12. Ohori M, Eastham JA, Koh H . Is focal therapy reasonable in patients with early stage prostate cancer (CAP)- an analysis of radical prostatectomy (RP) specimens. J Urol 2006; 175 (suppl): 507.

    Article  Google Scholar 

  13. Wise AM, Stamey TA, McNeal JE, Clayton JL . Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 2002; 60: 264–269.

    Article  PubMed  Google Scholar 

  14. Rashid M, Wojno KJ, Marcovich R, Rubin M, Montie JE, Sanda MG . Maximum tumor dimension provides a clinically useful and independently significant measure for predicting PSA-free survival following radical prostatectomy. J Urol 1999; 161 (suppl): 241.

    Article  Google Scholar 

  15. Haggman M, Nordin B, Mattson S, Busch C . Morphometric studies of intra-prostatic volume relationships in localized prostatic cancer. Br J Urol 1997; 80: 612–617.

    Article  CAS  PubMed  Google Scholar 

  16. Eggener SE, Scardino PT, Carroll PR, Zelefsky MJ, Sartor O, Hricak H et al. Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 2007; 178: 2260–2267.

    Article  PubMed  Google Scholar 

  17. Scardino PT . Focal therapy for prostate cancer. Nat Rev Urol 2009; 6: 175.

    Article  PubMed  Google Scholar 

  18. Chen ME, Johnston D, Reyes AO, Soto CP, Babaian RJ, Troncoso P . A streamlined three-dimensional volume estimation method accurately classifies prostate tumors by volume. Am J Surg Pathol 2003; 27: 1291–1301.

    Article  PubMed  Google Scholar 

  19. Lerner SE, Seay TM, Blute ML, Bergstralh EJ, Barrett D, Zincke H . Prostate specific antigen detected prostate cancer (clinical stage T1c): an interim analysis. J Urol 1996; 155: 821–826.

    Article  CAS  PubMed  Google Scholar 

  20. Mouraviev V, Sun L, Madden JF, Mayes JM, Moul JW, Polascik TJ . Prostate cancer laterality does not predict prostate-specific antigen recurrence after radical prostatectomy. Urology 2007; 70: 1141–1145.

    Article  PubMed  Google Scholar 

  21. Ruijter ET, Miller GJ, van de Kaa CA, van Bokhoven A, Bussemakers MJ, Debruyne FM et al. Molecular analysis of multifocal prostate cancer lesions. J Pathol 1999; 188: 271–277.

    Article  CAS  PubMed  Google Scholar 

  22. Ruijter ET, van de Kaa CA, Schalken JA, Debruyne FM, Ruiter DJ . Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol 1996; 180: 295–299.

    Article  CAS  PubMed  Google Scholar 

  23. Tareen A, Sankin G, Godoy S, Temkin H, Lepor S, Taneja S . Men with unilateral prostate cancer have more favorable pathologic and oncologic outcomes than those with bilateral disease: implications for focal therapy. J Urol 2008; 179 (4 suppl): 396.

    Article  Google Scholar 

  24. Magi-Galluzzi C, Roma A, Jones S, Klein E, Zhou M . Pathologic features of single-nodule prostatic carcinoma. Lab Invest 2006; 86: 151A.

    Google Scholar 

  25. Noguchi M, Stamey TA, McNeal JE, Nolley R . Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. J Urol 2003; 170 (2 Pt 1): 459–463.

    Article  PubMed  Google Scholar 

  26. Schmidt H, DeAngelis G, Eltze E, Gockel I, Semjonow A, Brandt B . Asynchronous growth of prostate cancer is reflected by circulating tumor cells delivered from distinct, even small foci, harboring loss of heterozygosity of the PTEN gene. Cancer Res 2006; 66: 8959–8965.

    Article  CAS  PubMed  Google Scholar 

  27. Gburek BM, Kollmorgen TA, Qian J, D’Souza-Gburek SM, Lieber MM, Jenkins RB . Chromosomal anomalies in stage D1 prostate adenocarcinoma primary tumors and lymph node metastases detected by fluorescence in situ hybridization. J Urol 1997; 157: 223–227.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

HU Ahmed receives funding from the Medical Research Council, Pelican Cancer Foundation, Prostate UK, Prostate Cancer Research Centre and St Peters Trust for work on focal therapy.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M Karavitakis.

Ethics declarations

Competing interests

HU Ahmed receives funding from USHIFU/Misonix/UKHIFU/Focus Surgery (manufacturers and distributors of the Sonablate 500 HIFU device) for proctoring HIFU cases and travel grants to conferences.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karavitakis, M., Winkler, M., Abel, P. et al. Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy. Prostate Cancer Prostatic Dis 14, 46–52 (2011). https://doi.org/10.1038/pcan.2010.16

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2010.16

Keywords

This article is cited by

Search

Quick links