title: There is no way to identify patients who will harbor small volume, unilateral prostate cancer at final pathology. implications for focal therapies.
abstract: BACKGROUND
  The aim of this study was to assess the clinical characteristics of the potentially ideal candidates for focal therapy, that is, patients with unilateral, small volume (namely, pT2a) prostate cancer (PCa) at radical prostatectomy (RP).
  
  
  METHODS
  We evaluated 2,503 consecutive pT2 PCa patients treated with RP between 2002 and 2009 at a single center. Within this population, the clinical characteristics of patients with pT2a and pT2b/c disease were compared. Univariable and multivariable logistic regression models were fitted to assess clinical predictors of pT2a at RP.
  
  
  RESULTS
  Overall, 349 patients (14%) had pT2a PCa, while the remaining patients had either pT2b (n = 334; 15.5%) or pT2c disease (n = 1,820 patients; 84.5%). Patients with pT2a PCa had a significantly lower mean PSA value, lower mean percentage of positive biopsy cores and lower biopsy Gleason score distribution (all P ≤ 0.03). However, at multivariable analyses, only percentage of positive cores maintained an independent predictor status (P = 0.01). Even when considering only patients sharing all the most favorable PCa characteristics (namely, clinical stage T1, PSA ≤ 4, Gleason score ≤6 and percentage of positive cores ≤25%), the rate of pT2a disease was only 24%.
  
  
  CONCLUSIONS
  The rate of small volume, unilateral PCa even among patients with extremely favourable PCa characteristics was remarkably low (roughly 25%). This suggests that: (1) Three quarters of the best candidates for focal therapy would ultimately show adverse pathological features; (2) At present, accurate identification of the ideal candidate for focal therapy is not possible with current clinical-pathologic parameters.
authors.affiliation: Department of Urology, VitaSalute University, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. briganti_alberto@yahoo.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Manuela
authors.initials: M
authors.lastname: Tutolo
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies