Premium
Candidate selection for quadrant‐based focal ablation through a combination of diffusion‐weighted magnetic resonance imaging and prostate biopsy
Author(s) -
Matsuoka Yoh,
Numao Noboru,
Saito Kazutaka,
Tanaka Hiroshi,
Kumagai Jiro,
Yoshida Soichiro,
Ishioka Junichiro,
Koga Fumitaka,
Masuda Hitoshi,
Kawakami Satoru,
Fujii Yasuhisa,
Kihara Kazunori
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12901
Subject(s) - medicine , quadrant (abdomen) , biopsy , prostate cancer , prostatectomy , magnetic resonance imaging , radiology , ablation , sampling (signal processing) , prostate , cancer , surgery , filter (signal processing) , computer science , computer vision
Objectives To identify prostatic quadrants that could be preserved without intervention, using diffusion‐weighted magnetic resonance imaging ( DWI ) and extended core biopsy, as a step toward implementation of quadrant‐based focal ablation with potential preservation of erectile and ejaculatory functions, based on comparisons with unilateral hemi‐gland ablation. Patients and Methods We conducted a prebiopsy DWI study including 648 quadrants in 162 men who underwent 14‐core biopsy including anterior sampling and radical prostatectomy ( RP ) for localised cancer. Imaging and pathology were analysed on a quadrant basis. Each quadrant was assessed through four‐core sampling. Predictive performance of DWI and biopsy for quadrant status was analysed. Results On RP specimens, 170 anterior (52.5%) and 172 posterior quadrants (53.1%) harboured significant cancer. Negative predictive values of DWI , biopsy, and their combination for significant cancer were 79.7%, 70.6%, and 91.1%, respectively, in anterior quadrants, and 78.5%, 81.3%, and 91.7%, respectively, in posterior quadrants. DWI incrementally improved the negative predictive values of biopsy in anterior ( P < 0.001) and posterior quadrants ( P = 0.025), without untoward impacts on positive predictive values. Negative findings on both DWI and biopsy were identified in posterior quadrants of 109 sides (33.6%), but in entire hemi‐glands of 54 sides (16.7%). Conclusions The combination of DWI and 14‐core biopsy including anterior sampling efficiently identifies quadrants without significant cancer in men with localised prostate cancer; the remaining quadrants, therefore, could be potential candidate areas for focal ablation. Focal therapy designed based on quadrant‐based assessment could be superior to unilateral hemi‐gland ablation for preservation of posterior quadrants and retaining of sexual function in more sides.