Utilization of focal therapy for patients discontinuing active surveillance of prostate cancer: Recommendations of an international Delphi consensus

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...

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Bibliographic Details
Published in:	Urologic oncology Vol. 39; no. 11; pp. 781.e17 - 781.e24
Main Authors:	Tan, Wei Phin, Rastinehad, Ardeshir R., Klotz, Laurence, Carroll, Peter R., Emberton, Mark, Feller, John F., George, Arvin K., Gill, Inderbir S., Gupta, Rajan T., Katz, Aaron E., Lebastchi, Amir H., Marks, Leonard S., Marra, Giancarlo, Pinto, Peter A., Song, Daniel Y., Sidana, Abhinav, Ward, John F., Sanchez-Salas, Rafael, Rosette, Jean de la, Polascik, Thomas J, Katz, Aaron, Aminsharifi, Alireza, Lebastchi, Amir, Abreu, Andre, Villers, Arnauld, Schulman, Ariel, Rastinehad, Ardeshir, George, Arvin, Oto, Aytekin, Turkbey, Baris, Malavaud, Bernard, Muller, Berrend, Moore, Caroline, Eberli, Daniel, Margolis, Daniel, Song, Daniel, Lomas, Derek, Orabi, Hazem, Lepor, Herbert, Tan, Hui Meng, Jambor, Ivan, de la Rosette, Jean, Grummet, Jeremy, Feller, John, Ward, John, Colemen, Jonathan, Gregg, Justin, Tay, Kae Jack, Marks, Leonard, Deane, Leslie, Laguna, M. Pilar, Kimura, Masaki, Tsivian, Matvey, Gorin, Michael, Siddiqui, Minhaj, Ukimura, Osamu, Gontero, Paolo, Carroll, Peter, Pinto, Peter, Mozer, Pierre, Gupta, Rajan T, Arcot, Ro, Taneja, Samir, Ghai, Sangeet, Crouzet, Sebastian, Mehralivand, Sherif, Joniau, Steven, Shoji, Sunao, Shiraishi, Takumi, Polascik, Thomas, Shin, Toshitaka, Lindnet, Uri, Tammisetti, Varaha, van den Bos, Willemien, Matsuoka, Yoh
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-11-2021
Subjects:	Ablation Techniques - methods Active surveillance Aged Aged, 80 and over Consensus Delphi Technique Focal therapy Humans Localized prostate cancer Male Middle Aged Partial gland ablation Prostatic Neoplasms - pathology Prostatic Neoplasms - therapy Watchful Waiting HIFU AS Active surveillance CaP NCCN mpMRI MRI Partial gland ablation Localized prostate cancer Focal therapy FT PSA
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Summary:	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). 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. 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. 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.
ISSN:	1078-1439 1873-2496
DOI:	10.1016/j.urolonc.2021.01.027