5. Localisation of Cancer within the Gland: Biopsy Strategies

  1. Hashim U Ahmed MRCS, BM, BCh, BA(Hons)4,
  2. Manit Arya FRCS, FRCS(Urol)5,
  3. Peter Carroll MD, MPH6 and
  4. Mark Emberton FRCS (Urol), FRCS, MD, MBBS, BSc4,7
  1. Winston E. Barzell MD, FRCS, FACS1 and
  2. Rodrigo Pinochet MD2,3

Published Online: 10 NOV 2011

DOI: 10.1002/9781444346893.ch5

Focal Therapy in Prostate Cancer

Focal Therapy in Prostate Cancer

How to Cite

Barzell, W. E. and Pinochet, R. (2011) Localisation of Cancer within the Gland: Biopsy Strategies, 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.ch5

Editor Information

  1. 4

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

  2. 5

    Department of Urology, University College London, London, UK

  3. 6

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

  4. 7

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

Author Information

  1. 1

    FSU College of Medicine, Urology Treatment Center, Sarasota, FL, USA

  2. 2

    Memorial Sloan-Kettering Cancer Center, New York, NY, USA

  3. 3

    Department of Urology, Pontificia Universidad Catolica de Chile, Santiago, Chile

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:

  • restaging biopsy;
  • mapping biopsy;
  • focal therapy;
  • transperineal prostate biopsy;
  • targeted focal therapy;
  • cryotherapy;
  • three-dimensional pathologic mapping;
  • 3D-TPM;
  • TRUS-biopsy

Summary

The concept of focal therapy has been criticized on the basis that prostate cancer is frequently multifocal. Furthermore, the efficacy of focal therapy is unproven, and validated criteria for identifying patients who can be safely managed by this modality do not exist. Consequently, it is important that the selection process for patients undergoing this treatment precisely locates the targeted area to be selectively ablated. Given the limitations of our existing imaging modalities, the selection of patients for is currently best achieved by a comprehensive restaging biopsy procedure. This chapter explores the various restaging biopsy strategies, including saturation transrectal ultrasound biopsies (TRUS-biopsy), and transperineal three-dimensional template-guided pathologic mapping biopsies (3D-TPM). The technique of 3D-TPM is illustrated and the advantages and disadvantages of saturation TRUS-biopsy versus 3D-TPM are discussed, as they relate to the process of patient selection.