title: Suitability of PSA-detected localised prostate cancers for focal therapy: experience from the ProtecT study.
abstract: BACKGROUND
  Contemporary screening for prostate cancer frequently identifies small volume, low-grade lesions. Some clinicians have advocated focal prostatic ablation as an alternative to more aggressive interventions to manage these lesions. To identify which patients might benefit from focal ablative techniques, we analysed the surgical specimens of a large sample of population-detected men undergoing radical prostatectomy as part of a randomised clinical trial.
  
  
  METHODS
  Surgical specimens from 525 men who underwent prostatectomy within the ProtecT study were analysed to determine tumour volume, location and grade. These findings were compared with information available in the biopsy specimen to examine whether focal therapy could be provided appropriately.
  
  
  RESULTS
  Solitary cancers were found in prostatectomy specimens from 19% (100 out of 525) of men. In addition, 73 out of 425 (17%) men had multiple cancers with a solitary significant tumour focus. Thus, 173 out of 525 (33%) men had tumours potentially suitable for focal therapy. The majority of these were small, well-differentiated lesions that appeared to be pathologically insignificant (38-66%). Criteria used to select patients for focal prostatic ablation underestimated the cancer's significance in 26% (34 out of 130) of men and resulted in overtreatment in more than half. Only 18% (24 out of 130) of men presumed eligible for focal therapy, actually had significant solitary lesions.
  
  
  CONCLUSIONS
  Focal therapy appears inappropriate for the majority of men presenting with prostate-specific antigen-detected localised prostate cancer. Unifocal prostate cancers suitable for focal ablation are difficult to identify pre-operatively using biopsy alone. Most lesions meeting criteria for focal ablation were either more aggressive than expected or posed little threat of progression.
authors.affiliation: Academic Urology Unit and Institute for Cancer Studies, University of Sheffield, Sheffield, UK.
authors.forename: J W F
authors.initials: JW
authors.lastname: Catto
authors.forename: M C
authors.initials: MC
authors.lastname: Robinson
authors.forename: P C
authors.initials: PC
authors.lastname: Albertsen
authors.forename: J R
authors.initials: JR
authors.lastname: Goepel
authors.forename: M F
authors.initials: MF
authors.lastname: Abbod
authors.forename: D A
authors.initials: DA
authors.lastname: Linkens
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.forename: D J
authors.initials: DJ
authors.lastname: Rosario
authors.forename: A Y
authors.initials: AY
authors.lastname: Warren
authors.forename: M
authors.initials: M
authors.lastname: Varma
authors.forename: D F
authors.initials: DF
authors.lastname: Griffiths
authors.forename: K M
authors.initials: KM
authors.lastname: Grigor
authors.forename: N J
authors.initials: NJ
authors.lastname: Mayer
authors.forename: J D
authors.initials: JD
authors.lastname: Oxley
authors.forename: N S
authors.initials: NS
authors.lastname: Deshmukh
authors.forename: J A
authors.initials: JA
authors.lastname: Lane
authors.forename: C
authors.initials: C
authors.lastname: Metcalfe
authors.forename: J L
authors.initials: JL
authors.lastname: Donovan
authors.forename: D E
authors.initials: DE
authors.lastname: Neal
authors.forename: F C
authors.initials: FC
authors.lastname: Hamdy
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy*
chemical_list: D017430:Prostate-Specific Antigen