Intermediate Grade Prostate Cancer and Risk for Adverse Pathology Radical Prostatectomy: Implications for Partial Gland Ablation Case Selection

Partial gland ablation may be offered to men with MRI-visible localized prostate cancer (≤GG 3). Outcomes can be optimized with training, meticulous technique, patient selection, and rigorous oncological assessment. The method is limited by the energy source, the extent of the ablation zone, and post-treatment assessment of cancer cure. Also, few data are available for intermediate or long-term oncological outcomes.

We identified 161,536 men from the National Cancer Database, who would be potentially eligible for partial gland ablation but underwent radical prostatectomy and evaluated for predictors of adverse pathology, defined as ≥pT3, pN1, and GG upgrading (GG 4 or 5). Age, Hispanic race, PSA 10-20 ng/ml, cT2a and cT2b, and ≥50% positive biopsy cores were identified as significant risk factors.

Together, non-organ-confined prostate cancer remains underdetected using contemporary risk stratification tools. Better imaging and tissue-based biomarkers may help to overcome the current limitations of staging and grading of the disease.

Providers offering partial gland ablation should inform patients meticulously about the benefits and the risk of this technique, and select and follow cases carefully to ensure cancer control.

Written by: Judith Stangl-Kremser, MD, PhD, Neal Patel, MD, & Jim C. Hu, MD, MPH

Department of Urology, Weill Cornell Medicine, New York, NY

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