Prostate cancer multifocality, the index lesion, and the microenvironment

Area of Science:

• Oncology
• Urology
• Cancer Biology

Background:

• Prostate cancer (PCa) is a multifocal disease, yet focal therapies primarily target the index lesion.
• The tumor microenvironment (TME) significantly influences PCa growth, proliferation, and progression.
• Understanding the interplay between tumor foci and the prostatic microenvironment is critical.

Purpose of the Study:

• To review the biology of cancer foci in prostate cancer.
• To explore the interaction between tumor foci and the prostatic microenvironment following focal therapy.
• To highlight the role of TME and inflammation in PCa progression.

Main Methods:

• Review of current literature on prostate cancer multifocality and focal therapy.
• Analysis of the components of the tumor microenvironment (stromal, immune, tumoral).
• Discussion of diagnostic advancements like multiparametric MRI and biomarkers for patient selection.

Main Results:

• Index lesions represent PCa grade in low-risk patients; satellite lesions are significant in higher-risk patients.
• Multiparametric MRI, guided biopsies, and biomarkers are essential for addressing PCa multifocality and selecting patients for focal therapy.
• Stromal, immune, and tumoral components are integral to tumorigenesis and are altered by focal therapy-induced inflammation.

Conclusions:

• TME and inflammation are critical factors in PCa progression.
• Further research is needed to understand how prostate microenvironment components become protumoral and how focal therapy-induced inflammation affects them.
• Modulating the TME represents a promising avenue for improving PCa prevention and treatment.