Background: Focal therapy as a treatment option for localized prostate cancer (PCa) is
an increasingly popular and rapidly evolving field.
Objective: To gather expert opinion on patient selection, interventions, and meaningful
outcome measures for focal therapy in clinical practice and trial design.
Design, setting, and participants: Fifteen experts in focal therapy followed a modified
two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology
process. All participants independently scored 246 statements prior to rescoring at
a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of
Medicine, London, supported by the Wellcome Trust and the UK Department of Health.
Outcome measurements and statistical analysis: Agreement, disagreement, or uncertainty
were calculated as the median panel score. Consensus was derived from the
interpercentile range adjusted for symmetry level.
Results and limitations: Of 246 statements, 154 (63%) reached consensus. Items of
agreement included the following: patients with intermediate risk and patients
with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance
imaging–targeted or template-mapping biopsy should be used to plan treatment;
planned treatment margins should be 5 mm from the known tumor; prostate volume
or age should not be a primary determinant of eligibility; foci of indolent cancer can be
left untreated when treating the dominant index lesion; histologic outcomes should be
defined by targeted biopsy at 1 yr; residual disease in the treated area of 3 mm of
Gleason 3 + 3 did not need further treatment; and focal retreatment rates of 20%
should be considered clinically acceptable but subsequent whole-gland therapy deemeda failure of focal therapy. All statements are expert opinion and therefore constitute level
5 evidence and may not reflect wider clinical consensus.
Conclusions: The landscape of PCa treatment is rapidly evolving with new treatment
technologies. This consensus meeting provides guidance to clinicians on current expert
thinking in the field of focal therapy.
Patient summary: In this report we present expert opinion on patient selection, interventions,
and meaningful outcomes for clinicians working in focal therapy for prostate cancer.