The 77 men included in the study were identified from among 225 patients who had undergone salvage radical prostatectomy at MSKCC from 2000 to 2014. The remaining 148 men did not have a tumor map of the whole-mount specimen. A sensitivity analysis comparing the included and excluded groups showed that the included patients were representative of the entire cohort.
The 15 men who were identified as eligible for partial gland ablation based on their clinical characteristics had a mean age of 60 years. Median time from primary radiotherapy was 48 months. The index lesion (largest tumor mass with the highest Gleason grade) was located in the mid-gland in all men with extension to the apex in 77% of the men and to the base of the prostate in 15%.
“The index lesion appears to be located closer to the urethra, and the median distance of the index tumor to the urethra was 0.5 cm,” Dr. Sivaraman said.
“Based on these findings, we would propose that when salvage focal treatment is considered, the strategy should be a complete hemi-gland ablation including the periurethral tissue.”
Ten of the 15 men identified as eligible for partial gland ablation based on clinical criteria had undergone external beam radiation and the other five had brachytherapy. Dr. Sivaraman acknowledged that the quality of the MRI may be affected by prior radiotherapy seeds.
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