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Published on: October 10, 2019
Identifying the index lesion with template prostate mapping biopsies.
Massimo Valerio1, Chukwuemeka Anele2, Alex Freeman3
1Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College Hospitals National Health Service Foundation Trust, London, United Kingdom; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Transperineal template prostate mapping biopsies can identify the index lesion in most men with significant prostate cancer. This localization is crucial for selecting patients for targeted therapy and planning radical treatment strategies.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Prostate cancer progression is often influenced by the primary tumor, known as the index lesion.
- Accurate identification of the index lesion is essential for effective treatment planning.
Purpose of the Study:
- To determine the percentage of men in whom the index lesion can be identified using transperineal template prostate mapping biopsies.
- To assess the impact of different definitions of clinically significant disease and clustering rules on index lesion identification.
Main Methods:
- Transperineal template prostate mapping biopsies were performed on 391 men, with biopsies grouped into 20 zones.
- The index lesion was defined as clinically significant disease in only one prostate area.
- Two definitions for clinically significant disease (Gleason grade pattern 4 and/or lesion volume ≥0.5 cc) and two clustering rules (stringent and tolerant) were evaluated.
Main Results:
- Prostate cancer was diagnosed in 82.9% of men.
- Using stringent spatial clustering, 44.4%–54.6% of patients had one identifiable index lesion.
- Using tolerant spatial clustering, 46.6%–59.2% of patients had one identifiable index lesion.
Conclusions:
- Transperineal template prostate mapping biopsies effectively localize the index lesion in the majority of men with clinically significant prostate cancer.
- This precise localization aids in selecting candidates for targeted therapies.
- The findings support the use of this technique for tailored treatment strategies in prostate cancer management.
