Unilateral prostate cancer cannot be accurately predicted in low-risk patients.
OBJECTIVE
Hemiablative therapy (HAT) is increasing in popularity for treatment of patients with low-risk prostate cancer (PCa). The validity of this therapeutic modality, which exclusively treats PCa within a single prostate lobe, rests on accurate staging. We tested the accuracy of unilaterally unremarkable biopsy findings in cases of low-risk PCa patients who are potential candidates for HAT.


METHODS
The study population consisted of 243 men with clinical stage <or=T2a, a prostate-specific antigen (PSA) concentration of <10 ng/ml, a biopsy-proven Gleason sum of <or=6, and a maximum of 2 ipsilateral positive biopsy results out of 10 or more cores. All men underwent a radical prostatectomy, and pathology stage was used as the gold standard. Univariable and multivariable logistic regression models were tested for significant predictors of unilateral, organ-confined PCa. These predictors consisted of PSA, % fPSA (defined as the quotient of free [uncomplexed] PSA divided by the total PSA), clinical stage (T2a vs. T1c), gland volume, and number of positive biopsy cores (2 vs. 1).


RESULTS
Despite unilateral stage at biopsy, bilateral or even non-organ-confined PCa was reported in 64% of all patients. In multivariable analyses, no variable could clearly and independently predict the presence of unilateral PCa. This was reflected in an overall accuracy of 58% (95% confidence interval, 50.6-65.8%).


CONCLUSIONS
Two-thirds of patients with unilateral low-risk PCa, confirmed by clinical stage and biopsy findings, have bilateral or non-organ-confined PCa at radical prostatectomy. This alarming finding questions the safety and validity of HAT.
Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. hendrikisbarn@gmail.com
Hendrik
H
Isbarn
Pierre I
PI
Karakiewicz
Susanne
S
Vogel
Claudio
C
Jeldres
Giovanni
G
Lughezzani
Alberto
A
Briganti
Francesco
F
Montorsi
Paul
P
Perrotte
Sascha A
SA
Ahyai
Lars
L
Budäus
Christian
C
Eichelberg
Roman
R
Heuer
Jens
J
Köllermann
Guido
G
Sauter
Thorsten
T
Schlomm
Thomas
T
Steuber
Alexander
A
Haese
Mario
M
Zacharias
Margit
M
Fisch
Hans
H
Heinzer
Hartwig
H
Huland
Felix K H
FK
Chun
Markus
M
Graefen
D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery
D017430:Prostate-Specific Antigen