Boston—Information from magnetic resonance imaging (MRI) and systematic biopsy may be used to identify candidates for partial gland ablation among men with recurrent localized prostate cancer after radiation therapy, researchers from Memorial Sloan Kettering Cancer Center (MSKCC) reported at the AUA annual meeting in Boston.
The feasibility of using the MRI and systematic biopsy characteristics for determining the topographic location of the tumor in the prostate was investigated in a study including 77 men who had a tumor map created from entirely submitted, whole-mounted specimens after undergoing salvage radical prostatectomy. Using a priori clinical criteria that required the presence of biopsy-proven unilateral disease concordant with a region of interest on MRI and absence of MRI findings suspicious for extracapsular extension, seminal vesicle invasion, or lymph node involvement, 15 of the 77 patients were identified as being eligible for partial gland ablation.
Use of the clinical criteria for patient selection demonstrated 100% specificity—all 15 patients were confirmed to have unilateral cancer without adverse pathologic features when their tumor maps were reviewed by a single, blinded pathologist. The selection approach had a sensitivity of 65% because eight men who would have been eligible for partial gland ablation according to tumor map review were not identified using the clinical criteria.
“Men with prostate cancer recurrence after radiation therapy are not uncommon and more often treated with androgen deprivation therapy. Salvage partial gland ablation can be a potential treatment alternative in carefully selected patients with organ-confined recurrent cancer. Our findings support the feasibility of using MRI and biopsy characteristics to select patients for salvage partial gland ablation,” said first author Arjun Sivaraman, MD, a Society of Urologic Oncology fellow at MSKCC, New York, who worked on the study with Behfar Ehdaie, MD, MPH, and colleagues.
“However, we recognize that our study is limited by its small population. Therefore, definitive recommendations about use of this technique are pending further investigation. Accumulating a larger number of cases will take time, however, considering that radical prostatectomy is not frequently performed in the salvage setting,” Dr. Sivaraman told Urology Times.