It has been suggested that in multifocal prostate cancer (PCa), focal therapy to the largest (index) lesion is sufficient, because secondary non-index lesions are unlikely to contribute to disease progression. In this study, the role of PCa focality in selecting men for focal therapy was evaluated. A histopathological analysis of the index and non-index lesions of 100 consecutive radical prostatectomy specimens was carried out. Cases that would have been suitable for focal ablation were also evaluated. Tumours were more often multifocal (78%) and bilateral (86%). In total, 270 tumour foci were identified. In multifocal disease, tumour volume, Gleason score and pathological stage were almost invariably defined by the index lesion of the specimen; among the 170 satellite foci, 148 (87%) were <0.5 cm(3) and 169 (99.4%) had Gleason score ≤ 6. Using the defined criteria, 51% of men in this series would have been considered suitable for focal ablation of the index lesion. Histological features of poor prognosis in the prostate are associated with the index lesion. There is a high proportion of patients who may be suitable for focal therapy, and clinical trials of index lesion ablation should be considered as part of this therapeutic strategy.

中文翻译：

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整体根治性前列腺切除术标本中指标病变的组织学特征：对局部治疗的影响。

有人提出，在多灶性前列腺癌 (PCa) 中，对最大（指标）病变进行局部治疗就足够了，因为继发性非指标病变不太可能导致疾病进展。在这项研究中，评估了 PCa 焦点在选择男性进行焦点治疗方面的作用。对 100 个连续根治性前列腺切除术标本的指标和非指标病变进行了组织病理学分析。还评估了适合局部消融的病例。肿瘤多为多灶性 (78%) 和双侧 (86%)。总共确定了270个肿瘤病灶。在多灶性病变中，肿瘤体积、Gleason 评分和病理分期几乎总是由标本的指标病变定义；在 170 个卫星病灶中，148 个 (87%) <0.5 cm(3) 和 169 个 (99.4%) 的 Gleason 评分 ≤ 6。使用定义的标准，该系列中 51% 的男性被认为适合指示病变的局部消融。前列腺预后不良的组织学特征与指标病变相关。有很高比例的患者可能适合局部治疗，指标病灶消融的临床试验应被视为该治疗策略的一部分。