MP70-05 DEFINING THE INDEX LESION FOR SALVAGE PARTIAL GLAND ABLATION AFTER RADIATION THERAPY FOR LOCALIZED PROSTATE CANCER (2017)

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I1 Apr 2017MP70-05 DEFINING THE INDEX LESION FOR SALVAGE PARTIAL GLAND ABLATION AFTER RADIATION THERAPY FOR LOCALIZED PROSTATE CANCER Arjun Sivaraman, Toshikazu Takeda, Hebert Alberto Vargas, Samson Fine, James Eastham, and Behfar Ehdaie Arjun SivaramanArjun Sivaraman More articles by this author , Toshikazu TakedaToshikazu Takeda More articles by this author , Hebert Alberto VargasHebert Alberto Vargas More articles by this author , Samson FineSamson Fine More articles by this author , James EasthamJames Eastham More articles by this author , and Behfar EhdaieBehfar Ehdaie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2281AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial gland ablation (PGA) is a promising treatment for selected patients with recurrent localized prostate cancer after radiation therapy. Our objective was to evaluate the impact of MRI and systematic biopsy characteristics to identify the index lesion for salvage partial gland ablation using tumor maps from whole mount slides of salvage radical prostatectomy (sRP) specimen. METHODS We identified 225 patients who underwent sRP between 2000 and 2014 and a tumor map was created from whole-mount slides in 77 patients. Among these patients, we selected men with a priori pre-treatment criteria considered eligible for PGA, including, biopsy proven unilateral disease concordant with a region of interest (ROI) on MRI, and excluding men with imaging suspicious for extra-capsular extension (ECE), seminal vesicle Invasion (SVI) or lymph node involvement (LNI). We describe the correlation between pre-treatment clinical characteristics and final radical prostatectomy whole mount specimen to select men eligible for PGA defined as hemi-gland ablation. RESULTS Among 77 patients with a tumor map of entirely-submitted and whole-mounted specimens, 15 patients were determined to be eligible for partial gland ablation based on pre-treatment clinical characteristics. The mean age was 60 years and median time from primary RT was 48 months. The median (IQR) tumor volume of the index lesion was 0.3 (0.4) cc. The location of the index lesion was determined to be the apex, mid-gland and base in 77%, 100% and 15% of patients, respectively. The median distance of the index tumor to the urethra was 0.5 (0.2) cm. The index tumor was confined to one lobe and concordant to the biopsy pathology and MRI data in all 15 patients (100%). There was no ECE, LNI or SVI identified in the sRP specimens. To account for those patients who did not have a tumor map of the whole-mount specimen, a sensitivity analysis was performed and determined that the clinical characteristics of the 77 patients with tumor maps were comparable to the entire 225 sRP cohort. CONCLUSIONS Clinical characteristics guided by biopsy findings and MRI data can be used to select men for PGA with recurrent localized prostate cancer after radiation therapy. Based on tumor maps from whole-mount slides of sRP specimen, we propose that salvage hemi-gland ablation including periurethral tissue is feasible in select patients with biopsy proven unilateral disease concordant with MRI data. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e936 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Arjun Sivaraman More articles by this author Toshikazu Takeda More articles by this author Hebert Alberto Vargas More articles by this author Samson Fine More articles by this author James Eastham More articles by this author Behfar Ehdaie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...