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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. Focal therapy: patients, interventions, and outcomes--a report from a consensus meeting. Eur Urol 2015; 67:771-7. [PMID: 25281389 PMCID: PMC4410301 DOI: 10.1016/j.eururo.2014.09.018] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/11/2014] [Indexed: 11/26/2022]
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 5mm 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 deemed a 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.
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Affiliation(s)
- Ian A Donaldson
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
| | - Roberto Alonzi
- Department of Clinical Oncology, Royal Marsden Hospital, London, UK
| | - Dean Barratt
- Centre for Medical Image Computing, University College London, London, UK
| | - Eric Barret
- Department of Urology, L'Institut Mutualiste Montsouris, Paris, France
| | - Viktor Berge
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Simon Bott
- Department of Urology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - David Bottomley
- Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Scott Eggener
- Section of Urology, University of Chicago Medical Center, Chicago, IL, USA
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Richard Hindley
- Department of Urology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas J Polascik
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Lucy Simmons
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Arnauld Villers
- Department of Urology, Hôpital Huriez, CHRU Lille, Lille, France
| | - Sarah Willis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
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