3. Histological Trends and the Index Lesion in Localized Prostate Cancer

  1. Hashim U Ahmed MRCS, BM, BCh, BA(Hons)5,
  2. Manit Arya FRCS, FRCS(Urol)6,
  3. Peter Carroll MD, MPH7 and
  4. Mark Emberton FRCS (Urol), FRCS, MD, MBBS, BSc5,8
  1. Vladimir Mouraviev MD1,
  2. Thomas M. Wheeler MD2 and
  3. Thomas J. Polascik MD, FACS1,3,4

Published Online: 10 NOV 2011

DOI: 10.1002/9781444346893.ch3

Focal Therapy in Prostate Cancer

Focal Therapy in Prostate Cancer

How to Cite

Mouraviev, V., Wheeler, T. M. and Polascik, T. J. (2011) Histological Trends and the Index Lesion in Localized Prostate Cancer, in Focal Therapy in Prostate Cancer (eds H. U. Ahmed, M. Arya, P. Carroll and M. Emberton), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346893.ch3

Editor Information

  1. 5

    Division of Surgery and Interventional Sciences, University College London, London, UK

  2. 6

    Department of Urology, University College London, London, UK

  3. 7

    Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA

  4. 8

    NIHR UCL/UCH Comprehensive Biomedical Research Centre, London, UK

Author Information

  1. 1

    Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

  2. 2

    Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA

  3. 3

    Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, NC, USA

  4. 4

    Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA

Publication History

  1. Published Online: 10 NOV 2011
  2. Published Print: 2 OCT 2011

ISBN Information

Print ISBN: 9781405196499

Online ISBN: 9781444346893

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Keywords:

  • index lesion;
  • multifocal;
  • unifocal;
  • unilateral;
  • monoclonal origin;
  • clinically significant cancer;
  • genetic heterogeneity;
  • field effect

Summary

This chapter comprehensively reviews the histological trends of prostate cancer in the PSA era. Men are increasingly diagnosed with low volume and risk disease, and a significant proportion have either unilateral or unifocal cancer. The chapter will also review the evidence for and against the concept of the index lesion—the lesion that is often the largest or holds the highest Gleason grade and is believed to determine the natural history of the disease rather than smaller, lower grade tumors.