Clinicopathological behavior of single focus prostate adenocarcinoma

With the increasing use of focal therapy for prostate adenocarcinoma a pathological basis for its appropriate application must be established. We determined the clinicopathological characteristics and natural history of single focus prostate cancer since this entity seems to be the ideal target for focal therapy.

We queried the Center for Prostate Disease Research database for all patients who underwent radical prostatectomy at Walter Reed Army Medical Center from 1993 through 2008. Patients with single focus prostate adenocarcinoma were compared with those who had multifocal disease. Primary outcomes were surgical margin status, pathological stage and biochemical recurrence. Secondary outcomes were Gleason score and total tumor volume.

A total of 1,159 men were included in the study. Multifocal disease was present in 1,056 patients (99.1%) and 103 (8.9%) had single focus disease. There were statistically higher rates of positive surgical margins (41.0% vs 29.9%, p = 0.0012), Gleason score 8-10 disease (18.7% vs 10.1%, p = 0.0362) and biochemical recurrence (38.5% vs 24.2%, p = 0.0021) in the single focus and multifocal groups, respectively. The single focus group had significantly worse biochemical recurrence-free survival compared to the multifocal group (p = 0.0017).

Single focus prostate cancer appears to have more aggressive behavior than multifocal disease. These findings support an aggressive, disciplined pretreatment evaluation to define disease site, extent and grade before focal therapy.