Multifocal prostate cancer: biologic, prognostic, and therapeutic implications

Summary 

Prostatic adenocarcinoma is the most common cancer diagnosed in men and is often multifocal. Ongoing controversy exists about the most appropriate system of tumor classification and grading and the optimal curative treatment approaches. This review examines recent progress in the pathogenesis of multifocal prostatic adenocarcinoma and its biologic, pathologic, prognostic, and therapeutic implications. Prostatic cancer multifocality makes accurate clinical staging difficult, and repeated revisions have been undertaken in an effort to optimize prognostic accuracy. Although the 2010 revision represents an improvement over the previous systems, the clinical significance of the T2 substaging is questionable. Also discussed is the potential impact of tumor multifocality and clonal heterogeneity on the oncologic efficacy of novel focal ablative approaches. The clinical significance of smaller secondary tumors and the relationship between extent of chromosomal abnormalities and the metastatic potential of an individual tumor focus were reviewed.

Keywords: Prostate, Prostatectomy, Multifocal, Tumor heterogeneity, Carcinogenesis, Precursor lesions, Prostatic intraepithelial neoplasia (PIN), Field effect, Tumor volume, Staging, Gleason grade, Molecular genetics, TMPRSS2-ERG gene fusion