Wei Phin Tan1, Ardeshir R Rastinehad2, Laurence Klotz3, Peter R Carroll4, Mark Emberton5, John F Feller6, Arvin K George7, Inderbir S Gill8, Rajan T Gupta9, Aaron E Katz10, Amir H Lebastchi8, Leonard S Marks11, Giancarlo Marra12, Peter A Pinto13, Daniel Y Song14, Abhinav Sidana15, John F Ward16, Rafael Sanchez-Salas12, Jean de la Rosette17, Thomas J Polascik18. 1. Division of Urology, Duke University Medical Center, Durham, NC. 2. Department of Urology, Northwell Health, New York City, NY. 3. Department of Urology, University of Toronto, Toronto, Ontario. 4. Department of Urology, University of California San Francisco, San Francisco, CA. 5. Division of Surgery and Interventional Science, University College London, London, United Kingdom. 6. HALO Diagnostics, Indian Wells, CA. 7. Department of Urology, University of Michigan, Ann Arbor, MI. 8. Department of Urology, University of Southern California, Los Angeles, CA. 9. Department of Radiology, Duke University Medical Center, Durham, NC. 10. Department of Urology, New York University, New York City, NY. 11. Department of Urology, University of California Los Angeles, Los Angeles, CA. 12. L'Institut Mutualiste Montsouris, Paris, France. 13. Urologic Oncology Branch of the National Cancer Institute, Bethesda, MD. 14. Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD. 15. Department of Urology, University of Cincinnati, Cincinnati, OH. 16. Department of Urology, MD Anderson Cancer Center, Houston, TX. 17. Department of Urology, Istanbul Medipol University, Istanbul, Turkey. 18. Division of Urology, Duke University Medical Center, Durham, NC. Electronic address: thomas.polascik@duke.edu.
Abstract
BACKGROUND: With the advancement of imaging technology, focal therapy (FT) has been gaining acceptance for the treatment of select patients with localized prostate cancer (CaP). We aim to provide details of a formal physician consensus on the utilization of FT for patients with CaP who are discontinuing active surveillance (AS). METHODS: A 3-stage Delphi consensus on CaP and FT was conducted. Consensus was defined as agreement by ≥80% of physicians. An in-person meeting was attended by 17 panelists to formulate the consensus statement. RESULTS: Fifty-six respondents participated in this interdisciplinary consensus study (82% urologist, 16% radiologist, 2% radiation oncology). The participants confirmed that there is a role for FT in men discontinuing AS (48% strongly agree, 39% agree). The benefit of FT over radical therapy for men coming off AS is: less invasive (91%), has a greater likelihood to preserve erectile function (91%), has a greater likelihood to preserve urinary continence (91%), has fewer side effects (86%), and has early recovery post-treatment (80%). Patients will need to undergo mpMRI of the prostate and/or a saturation biopsy to determine if they are potential candidates for FT. Our limitations include respondent's biases and that the participants of this consensus may not represent the larger medical community. CONCLUSIONS: FT can be offered to men coming off AS between the age of 60 to 80 with grade group 2 localized cancer. This consensus from a multidisciplinary, multi-institutional, international expert panel provides a contemporary insight utilizing FT for CaP in select patients who are discontinuing AS.
BACKGROUND: With the advancement of imaging technology, focal therapy (FT) has been gaining acceptance for the treatment of select patients with localized prostate cancer (CaP). We aim to provide details of a formal physician consensus on the utilization of FT for patients with CaP who are discontinuing active surveillance (AS). METHODS: A 3-stage Delphi consensus on CaP and FT was conducted. Consensus was defined as agreement by ≥80% of physicians. An in-person meeting was attended by 17 panelists to formulate the consensus statement. RESULTS: Fifty-six respondents participated in this interdisciplinary consensus study (82% urologist, 16% radiologist, 2% radiation oncology). The participants confirmed that there is a role for FT in men discontinuing AS (48% strongly agree, 39% agree). The benefit of FT over radical therapy for men coming off AS is: less invasive (91%), has a greater likelihood to preserve erectile function (91%), has a greater likelihood to preserve urinary continence (91%), has fewer side effects (86%), and has early recovery post-treatment (80%). Patients will need to undergo mpMRI of the prostate and/or a saturation biopsy to determine if they are potential candidates for FT. Our limitations include respondent's biases and that the participants of this consensus may not represent the larger medical community. CONCLUSIONS: FT can be offered to men coming off AS between the age of 60 to 80 with grade group 2 localized cancer. This consensus from a multidisciplinary, multi-institutional, international expert panel provides a contemporary insight utilizing FT for CaP in select patients who are discontinuing AS.
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