Focal Therapy: Patients, Interventions, and Outcomes-A Report from a Consensus Meeting

Title: Focal Therapy: Patients, Interventions, and Outcomes-A Report from a Consensus Meeting
Authors: Donaldson, IA
Alonzi, R
Barratt, D
Barret, E
Berge, V
Bott, S
Bottomley, D
Eggener, S
Ehdaie, B
Emberton, M
Hindley, R
Leslie, T
Miners, A
McCartan, N
Moore, CM
Pinto, P
Polascik, TJ
Simmons, L
Van der Meulen, J
Villers, A
Willis, S
Ahmed, HU
Item Type: Journal Article
Abstract: 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.
Issue Date: 1-Oct-2014
Date of Acceptance: 11-Sep-2014
ISSN: 0302-2838
Publisher: Elsevier
Start Page: 771
End Page: 777
Journal / Book Title: European Urology
Volume: 67
Issue: 4
Copyright Statement: © 2014 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/3.0/).
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
Prostatic neoplasms
Consensus development conference
Organ-sparing treatments
Magnetic Resonance Imaging
Middle Aged
Patient Selection
Prostate-Specific Antigen
Prostatic Neoplasms
Treatment Outcome
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine

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