Kae Jack Tay1,2, Mahul B Amin3, Sangeet Ghai4, Rafael E Jimenez5, James G Kench6, Laurence Klotz7, Rodolfo Montironi8, Satoru Muto9, Ardeshir R Rastinehad10, Baris Turkbey11, Arnauld Villers12, Thomas J Polascik13. 1. Division of Urology, Duke University, Durham, NC, USA. tay.kae.jack@singhealth.com.sg. 2. Department of Urology, Singapore General Hospital, SingHealth Duke-NUS Academic Medical Center, Singapore, Singapore. tay.kae.jack@singhealth.com.sg. 3. Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 4. Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. 5. Department of Pathology, Mayo Clinic, Rochester, MN, USA. 6. Department of Pathology, Royal Prince Alfred Hospital, Sydney, Australia. 7. Sunnybrook Research Institute, Toronto, ON, Canada. 8. School of Medicine, United Hospitals, Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region (Ancona), Ancona, Italy. 9. Department of Urology, Teikyo University, Tokyo, Japan. 10. Departments of Radiology and Urology, Icahn School of Medicine at Mount Sinai, New York, USA. 11. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 12. Department of Urology, University of Lille, Lille, France. 13. Division of Urology, Duke University, Durham, NC, USA.
Abstract
INTRODUCTION: Long-term outcomes from large cohorts are not yet available upon which to base recommended follow-up protocols after prostate focal therapy. This is an updated summary of a 2015 SIU-ICUD review of the best available current evidence and expert consensus on guidelines for surveillance after prostate focal therapy. METHODS: We performed a systematic search of the PubMed, Cochrane and Embase databases to identify studies where primary prostate focal therapy was performed to treat prostate cancer. RESULTS: Multiparametric magnetic resonance imaging (mpMRI) should be performed at 3-6 months, 12-24 months and at 5 years after focal therapy. Targeted biopsy of the treated zone should be performed at 3-6 months and fusion biopsy of any suspicious lesion seen on mpMRI. Additionally, a systematic biopsy should be performed at 12-24 months and again at 5 years. In histological diagnosis, characteristic changes of each treatment modality should be noted and in indeterminate situations various immunohistochemical molecular markers can be helpful. Small volume 3 + 3 (Prognostic grade group [PGG] 1) or very small volume (< 0.2 cc or < 7 mm diameter) 3 + 4 (PGG 2) are acceptable in the treated zone at longitudinal follow-up. Significant volumes of 3 + 4 (PGG 2) or more within the treated zone should be treated. Any clinically significant cancer subsequently arising within the non-treated zone should be treated and handled in the same way as any de novo prostate cancer. Patients should be counseled regarding whole-gland and focal approaches to treating these new foci where appropriate. One or two well-delineated foci of significant cancer can be ablated to keep the patient in the 'active surveillance pool'. More extensive disease should be treated with traditional whole-gland techniques. CONCLUSION: Focal therapy remains a nascent field largely comprising single center cohorts with little long-term data. Our current post-focal therapy surveillance consensus recommendations represent the synthesis of the best available evidence as well as expert opinion. Further work is necessary to define the most oncologically safe and cost-effective way of following patients after focal therapy.
INTRODUCTION: Long-term outcomes from large cohorts are not yet available upon which to base recommended follow-up protocols after prostate focal therapy. This is an updated summary of a 2015 SIU-ICUD review of the best available current evidence and expert consensus on guidelines for surveillance after prostate focal therapy. METHODS: We performed a systematic search of the PubMed, Cochrane and Embase databases to identify studies where primary prostate focal therapy was performed to treat prostate cancer. RESULTS: Multiparametric magnetic resonance imaging (mpMRI) should be performed at 3-6 months, 12-24 months and at 5 years after focal therapy. Targeted biopsy of the treated zone should be performed at 3-6 months and fusion biopsy of any suspicious lesion seen on mpMRI. Additionally, a systematic biopsy should be performed at 12-24 months and again at 5 years. In histological diagnosis, characteristic changes of each treatment modality should be noted and in indeterminate situations various immunohistochemical molecular markers can be helpful. Small volume 3 + 3 (Prognostic grade group [PGG] 1) or very small volume (< 0.2 cc or < 7 mm diameter) 3 + 4 (PGG 2) are acceptable in the treated zone at longitudinal follow-up. Significant volumes of 3 + 4 (PGG 2) or more within the treated zone should be treated. Any clinically significant cancer subsequently arising within the non-treated zone should be treated and handled in the same way as any de novo prostate cancer. Patients should be counseled regarding whole-gland and focal approaches to treating these new foci where appropriate. One or two well-delineated foci of significant cancer can be ablated to keep the patient in the 'active surveillance pool'. More extensive disease should be treated with traditional whole-gland techniques. CONCLUSION: Focal therapy remains a nascent field largely comprising single center cohorts with little long-term data. Our current post-focal therapy surveillance consensus recommendations represent the synthesis of the best available evidence as well as expert opinion. Further work is necessary to define the most oncologically safe and cost-effective way of following patients after focal therapy.
Authors: Rafael R Tourinho-Barbosa; Lucas Teixeira Batista; Xavier Cathelineau; Javier Sanchez-Macias; Rafael Sanchez-Salas Journal: Turk J Urol Date: 2020-10-09
Authors: Rafael R Tourinho-Barbosa; Bradford J Wood; Andre Luis Abreu; Bruno Nahar; Toshitaka Shin; Selcuk Guven; Thomas J Polascik Journal: World J Urol Date: 2020-05-22 Impact factor: 4.226
Authors: Ardeshir R Rastinehad; Harry Anastos; Ethan Wajswol; Jared S Winoker; John P Sfakianos; Sai K Doppalapudi; Michael R Carrick; Cynthia J Knauer; Bachir Taouli; Sara C Lewis; Ashutosh K Tewari; Jon A Schwartz; Steven E Canfield; Arvin K George; Jennifer L West; Naomi J Halas Journal: Proc Natl Acad Sci U S A Date: 2019-08-26 Impact factor: 11.205
Authors: Mark Paxton; Eitan Barbalat; Nathan Perlis; Ravi J Menezes; Mark Gertner; David Dragas; Masoom A Haider; Antonio Finelli; John Trachtenberg; Sangeet Ghai Journal: Br J Radiol Date: 2021-07-29 Impact factor: 3.039
Authors: Wei Phin Tan; Ardeshir R Rastinehad; Laurence Klotz; Peter R Carroll; Mark Emberton; John F Feller; Arvin K George; Inderbir S Gill; Rajan T Gupta; Aaron E Katz; Amir H Lebastchi; Leonard S Marks; Giancarlo Marra; Peter A Pinto; Daniel Y Song; Abhinav Sidana; John F Ward; Rafael Sanchez-Salas; Jean de la Rosette; Thomas J Polascik Journal: Urol Oncol Date: 2021-03-04 Impact factor: 3.498
Authors: Jost von Hardenberg; Hannes Cash; Daniel Koch; Angelika Borkowetz; Johannes Bruendl; Sami-Ramzi Leyh-Bannurah; Timur H Kuru; Karl-Friedrich Kowalewski; Daniel Schindele; Katharina S Mala; Niklas Westhoff; Andreas Blana; Martin Schostak Journal: World J Urol Date: 2021-04-21 Impact factor: 4.226
Authors: Amir H Lebastchi; Arvin K George; Thomas J Polascik; Jonathan Coleman; Jean de la Rosette; Baris Turkbey; Bradford J Wood; Michael A Gorin; Abhinav Sidana; Sangeet Ghai; Kae Jack Tay; John F Ward; Rafael Sanchez-Salas; Berrend G Muller; Bernard Malavaud; Pierre Mozer; Sebastien Crouzet; Peter L Choyke; Osamu Ukimura; Ardeshir R Rastinehad; Peter A Pinto Journal: Eur Urol Date: 2020-06-10 Impact factor: 20.096