Prostate cancer has a very varied biological potential and the clinical and prognostic significance of these smaller satellite lesions in men with multifocal prostate cancer is unknown. However, no tumor marker is definitive and only a needle biopsy of the prostate can definitively diagnose prostate cancer, assess Gleason score and suggest progression of the cancer.įor the significant index lesion then, what is a tumor volume demanding treatment? Do we consider focal treatment of just that index lesion (focal ablation) with a minimally invasive treatment option such as HIFU, cryo or laser and disregard the other smaller satellite lesions in a multifocal prostate cancer? On the other hand, a PSA density of 0.08ng/ml/cc at first re-biopsy is a significant predictor of prostate cancer progression and probable need for treatment. Smaller index tumor volumes,or, smaller total tumor volumes as in those with multifocal disease can probably forgo treatment but diligently followed through active surveillance (AS).ĭuring AS, PSA velocity (PSAV) monitoring can be valuable and a PSAV greater than 0.75ng/ml/year is associated significantly with prostate cancer and possibly progression. In attempting to sort out when a focus of prostate cancer becomes significant and needing treatment, there is some acceptance that an index lesion with a Gleason score of 6 or more and with a volume of >0.5 cm3 is a size where treatment may become necessary. One of these cancerous areas is commonly bigger in volume than the others and called the index lesion. In these prostates with multifocal cancer, however, the gland has on average 3-5 tumors in various stages of evolution. In other words, only about 25% of men may have a unifocal prostate cancer lesion that may be suitable for focal therapy. When prostates removed surgically for prostate cancer are examined, 50-75% of these specimens contain more than one area or focus of cancer and called multifocal prostate cancer.
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