We have determined that these mapping biopsies accurately predict the exact anatomical areas of cancer, allowing for targeted therapy. We have performed more than 500 of these biopsies. The morbidity is minimal and infectious complications less than those experienced via the transrectal route.4,5
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As discussed above, instead of removing or ablating the whole prostate, targeted therapy, also called focal therapy, treats only the part of the prostate where the cancer is located. Focal therapy is comparable to a lumpectomy done for breast cancer; instead of mastectomy, which involves the removal of the entire breast, a lumpectomy involves only the cancerous mass being removed, sparing the rest of the breast. A radical prostatectomy is like a mastectomy because the entire prostate is removed.
Mapping biopsies allow us to identify lesions and ablate them. Currently, we perform cryoablation. In our experience, about 30% to 40% of newly diagnosed patients are candidates for this type of therapy.
References
1. Crawford ED, Moul JW, Rove KO, et al. Prostate-specific antigen 1.5-4.0ng/mL: a diagnostic challenge and danger zone. BJU Int. 2011;108(11):1743-1749.
2. Crawford ED. PCA3: A Urine-Based Genetic Assay for Detection of Prostate Cancer in Men with Elevated PSA. Paper presented at: American Urologic Association 2009 Annual Meeting; May 31, 2009.
3. Crawford ED, Rove KO, Trabulsi EJ, et al. Diagnostic performance of PCA3 to detect prostate cancer in men with elevated PSA: a prospective study of 1,962 cases. J Urol. In press.
4. Crawford ED, Barqawi A. Targeted focal therapy: a minimally invasive ablation technique for early prostate cancer. Oncology (Williston Park). 2007;21(1):27-32; discussion 33-34, 39.
5. Barqawi AB, Rove KO, Gholizadeh S, et al. The role of 3-dimensional mapping biopsy in decision making for treatment of apparent early stage prostate cancer. J Urol. 2011;186(1):80-85.
