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Khoo CC, Miah S, Connor MJ, Tam J, Winkler M, Ahmed HU, Shah TT. A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer. Transl Androl Urol 2020; 9:1535-1545. [PMID: 32676441 PMCID: PMC7354313 DOI: 10.21037/tau.2019.08.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although radiotherapy to the prostate for cancer is effective, recurrence occurs in 10–15% within 5 years. Traditional salvage treatments for men with radiorecurrent prostate cancer comprise of watchful waiting (WW) with or without androgen deprivation therapy (ADT) or radical prostatectomy (RP). Neither strategy provides ideal therapeutic ratios. Salvage focal ablation is an emerging option. We performed a systematic review of the Medline and Embase databases for studies reporting outcomes of focal salvage brachytherapy (sBT), cryotherapy (sCT) or high-intensity focused ultrasound (sHIFU) for radiorecurrent prostate cancer (conception to April 2019). Results were screened for inclusion against predetermined eligibility criteria. Certain data were extracted, including rates of biochemical disease-free survival (BDFS), metastasis, conversion to second-line therapies and adverse events. Of a total 134 articles returned from the search, 15 studies (14 case series and 1 comparative study) reported outcomes after focal sBT [5], sCT [7] and sHIFU [3]. Cohort size varied depending on intervention, with eligible studies of sBT being small case series. Median follow-up ranged from 10 to 56 months. Although pre-salvage demographics were similar [median age range, 61–75 years; prostate-specific antigen (PSA) range, 2.8–5.5 ng/mL], there was heterogeneity in patient selection, individual treatment protocols and outcome reporting. At 3 years, BDFS ranged from 61% to 71.4% after sBT, 48.1–72.4% after sCT and 48% after sHIFU. Only studies of sCT reported 5-year BDFS, which ranged from 46.5% to 54.4%. Rates of metastasis were low after all salvage modalities, as were conversion to second-line therapies (although this was poorly reported). Grade 3 adverse events were rare. This systematic review indicates that salvage focal ablation of radiorecurrent prostate cancer provides acceptable oncological outcomes and is well tolerated. Unfortunately, there is heterogeneity in the study design of existing evidence. Level 1 research comparing salvage focal therapies to existing whole-gland strategies is needed to further establish the role of these promising treatments.
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Affiliation(s)
- Christopher C Khoo
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Saiful Miah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Joseph Tam
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
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Recurrence in prostate cancer: salvage diagnostic and therapeutic strategies. World J Urol 2019; 37:1467-1468. [DOI: 10.1007/s00345-019-02778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Luzurier A, Jouve De Guibert PH, Allera A, Feldman SF, Conort P, Simon JM, Mozer P, Compérat E, Boudghene F, Servois V, Lucidarme O, Granger B, Renard-Penna R. Dynamic contrast-enhanced imaging in localizing local recurrence of prostate cancer after radiotherapy: Limited added value for readers of varying level of experience. J Magn Reson Imaging 2018. [DOI: 10.1002/jmri.25991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Anna Luzurier
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
| | | | - Alexandre Allera
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
| | - Sarah F. Feldman
- Academic Departement of Statistic, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Pierre Conort
- Academic Department of Urology, Hopital Pitié-Salpétrière; AP-HP Sorbonne University; France
| | - Jean Marc Simon
- Academic Department of Radiotherapy, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Pierre Mozer
- Academic Department of Urology, Hopital Pitié-Salpétrière; AP-HP Sorbonne University; France
| | - Eva Compérat
- Academic Department of Pathology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Franck Boudghene
- Academic Department of Radiology, Hopital Tenon, AP-HP; Sorbonne University; France
| | - Vincent Servois
- Academic department of Radiology; Curie Institute, Descartes Univ Paris 05; Paris France
| | - Olivier Lucidarme
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
| | - Benjamin Granger
- Academic Departement of Statistic, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University; France
| | - Raphaele Renard-Penna
- Academic Department of Radiology, Hopital Pitié-Salpétrière, AP-HP; Sorbonne University Paris; France
- Academic Department of Radiology, Hopital Tenon, AP-HP; Sorbonne University; France
- GRC-UPMC Oncotype-URO; Sorbonne University; Paris France
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Demirkol MO, Kiremit MC, Acar O, Falay O, Ucar B, Esen T. Local Salvage Treatment of Post-brachytherapy Recurrent Prostate Cancer via Theranostic Application of PSMA-labeled Lutetium-177. Clin Genitourin Cancer 2017; 16:99-102. [PMID: 29074285 DOI: 10.1016/j.clgc.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Mehmet Onur Demirkol
- Department of Nuclear Medicine and Molecular Imaging, Koc University School of Medicine, Istanbul, Turkey; Department of Nuclear Medicine and Molecular Imaging, VKF American Hospital, Istanbul, Turkey
| | | | - Omer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Okan Falay
- Department of Nuclear Medicine and Molecular Imaging, Koc University Hospital, Istanbul, Turkey
| | - Burcu Ucar
- Department of Nuclear Medicine and Molecular Imaging, VKF American Hospital, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
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Kanthabalan A, Peters M, Van Vulpen M, McCartan N, Hindley RG, Emara A, Moore CM, Arya M, Emberton M, Ahmed HU. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. BJU Int 2017; 120:246-256. [DOI: 10.1111/bju.13831] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abi Kanthabalan
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Max Peters
- Department of Radiation Oncology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Marco Van Vulpen
- Department of Radiation Oncology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Neil McCartan
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | | | - Amr Emara
- Department of Urology; Hampshire Hospitals NHS Foundation Trust; Basingstoke UK
| | - Caroline M. Moore
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Manit Arya
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Mark Emberton
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Hashim Uddin Ahmed
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
- Division of Surgery; Department of Surgery and Cancer; Faculty of Medicine; Imperial College London; London UK
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Capogrosso P, Barret E. High-Intensity Focused Ultrasound. IMAGING AND FOCAL THERAPY OF EARLY PROSTATE CANCER 2017. [DOI: 10.1007/978-3-319-49911-6_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Kanthabalan A, Abd-Alazeez M, Arya M, Allen C, Freeman A, Jameson C, Kirkham A, Mitra A, Payne H, Punwani S, Ramachandran N, Walkden M, Emberton M, Ahmed H. Transperineal Magnetic Resonance Imaging-targeted Biopsy versus Transperineal Template Prostate Mapping Biopsy in the Detection of Localised Radio-recurrent Prostate Cancer. Clin Oncol (R Coll Radiol) 2016; 28:568-76. [DOI: 10.1016/j.clon.2016.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/19/2016] [Accepted: 03/08/2016] [Indexed: 12/14/2022]
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Zdrojowy R, Dembowski J, Małkiewicz B, Tupikowski K, Krajewski W. Salvage local therapy for radiation-recurrent prostate cancer - where are we? Cent European J Urol 2016; 69:264-270. [PMID: 27729992 PMCID: PMC5057051 DOI: 10.5173/ceju.2016.832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/07/2016] [Accepted: 06/08/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Prostate cancer is the most frequent cancer among males in Europe and a leading cause of cancer deaths, with similar proportion in other developed countries. For more than twenty years, external-beam radiation therapy, alongside with radical prostatectomy, has been used as a primary radical therapeutic approach for localized prostate cancer. Yet, EBRT failures relate to 22-69% following curative radiotherapy (± androgen deprivation therapy). Additionally, a proportion of these men will have a biopsy-proven local recurrence. MATERIAL AND METHODS The Medline and Web of Science databases were searched without a time limit during March 2016 using the terms 'prostate cancer' in conjunction with 'radiotherapy', 'recurrence', 'biochemical', 'salvage', 'brachytherapy', 'prostatectomy', 'HIFU', 'cryotherapy' and 'focal'. The search was limited to the English, Polish, German and Spanish literature. RESULTS Currently, salvage treatment after failed radiotherapy includes radical prostatectomy, brachytherapy and ablative whole-gland therapies, such as cryotherapy and high intensity focused ultrasound. New approaches, so called focal salvage therapy, involve ablation of only the zone of recurrence in order to decrease tissue injury and therefore to diminish morbidity. CONCLUSIONS At present no authoritative recommendations can be concluded because of the absence of randomized data with standardized definitions and protocols. Nevertheless, we believe that local salvage treatment should be at least considered in patients after biochemical relapse following radiotherapy.
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Affiliation(s)
- Romuald Zdrojowy
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Janusz Dembowski
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Tupikowski
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
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Detection of locally radio-recurrent prostate cancer at multiparametric MRI: Can dynamic contrast-enhanced imaging be omitted? Diagn Interv Imaging 2016; 97:433-41. [PMID: 26928245 DOI: 10.1016/j.diii.2016.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/17/2016] [Accepted: 01/26/2016] [Indexed: 11/21/2022]
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Salvage Brachytherapy for Biochemically Recurrent Prostate Cancer following Primary Brachytherapy. Prostate Cancer 2016; 2016:9561494. [PMID: 27092279 PMCID: PMC4820628 DOI: 10.1155/2016/9561494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/22/2016] [Accepted: 02/22/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. In this study, we evaluated our experience with salvage brachytherapy after discovery of biochemical recurrence after a prior brachytherapy procedure. Methods and Materials. From 2001 through 2012 twenty-one patients treated by brachytherapy within University of Kentucky or from outside centers developed biochemical failure and had no evidence of metastases. Computed tomography (CT) scans were evaluated; patients who had an underseeded portion of their prostate were considered for reimplantation. Results. The majority of the patients in this study (61.9%) were low risk and median presalvage PSA was 3.49 (range 17.41-1.68). Mean follow-up was 61 months. At last follow-up after reseeding, 11/21 (52.4%) were free of biochemical recurrence. There was a trend towards decreased freedom from biochemical recurrence in low risk patients (p = 0.12). International Prostate Symptom Scores (IPSS) increased at 3-month follow-up visits but decreased and were equivalent to baseline scores at 18 months. Conclusions. Salvage brachytherapy after primary brachytherapy is possible; however, in our experience the side-effect profile after the second brachytherapy procedure was higher than after the first brachytherapy procedure. In this cohort of patients we demonstrate that approximately 50% oncologic control, low risk patients appear to have better outcomes than others.
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Kaljouw E, Pieters BR, Kovács G, Hoskin PJ. A Delphi consensus study on salvage brachytherapy for prostate cancer relapse after radiotherapy, a Uro-GEC study. Radiother Oncol 2016; 118:122-30. [DOI: 10.1016/j.radonc.2015.10.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/07/2015] [Accepted: 10/19/2015] [Indexed: 11/30/2022]
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Siddiqui KM, Billia M, Williams A, Alzahrani A, Chin JL. Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer. Can Urol Assoc J 2015; 9:325-9. [PMID: 26644804 DOI: 10.5489/cuaj.3113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We compared the morbidity of whole gland salvage ablation using cryotherapy (CRYO) and high-intensity focused ultrasound (HIFU) for radio recurrent prostate cancer at a single centre over a 17-year period. METHODS Patients were divided in 3 cohorts. Group 1 included the first 65 patients treated with CRYO (1995-1998); Group 2 included the last 65 patients treated with CRYO (2002-2004), and Group 3 included 65 patients treated with HIFU (2006-2011). We analyzed the complications reported within at least 90 days of treatment or up to the last follow-up. RESULTS We tallied Clavien grade complications. For Groups 1, 2 and 3, we recorded the following Clavien I-II complications: 78, 49 and 13, respectively. For Clavien grade IIIa, 2, 5 and 4 for Groups 1, 2 and 3, respectively. For Clavien grade IIIb, 8, 2 and 3 for Groups 1, 2 and 3, respectively. Clavien grade II complications were statistically higher in Group 1 versus Group 2 (p = 0.005) and in Group 2 versus Group 3 (p = 0.0001). The rate of mild-moderate incontinence was significantly higher in the CRYO group compared to the HIFU cohort (p ≤ 0.05). The rate of urinary retention was significantly higher in Group 2 compared to Group 3 (p = 0.0005). The rates of severe incontinence (range: 1.5%-5%), need for surgical intervention (uniform at 1.5%), and recto-urethral fistulae (range: 1.5%-3%) were not statistically different. CONCLUSIONS CRYO was associated with higher overall morbidity. The morbidity during the early experience with HIFU was lower than both subgroups of CRYO. This may reflect the advancement of technology or cumulative learning experience.
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Affiliation(s)
| | | | | | - Ali Alzahrani
- Department of Urology, University of Dammam, Saudi Arabia
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Philippou Y, Parker RA, Volanis D, Gnanapragasam VJ. Comparative Oncologic and Toxicity Outcomes of Salvage Radical Prostatectomy Versus Nonsurgical Therapies for Radiorecurrent Prostate Cancer: A Meta-Regression Analysis. Eur Urol Focus 2015; 2:158-171. [PMID: 28723532 DOI: 10.1016/j.euf.2015.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/20/2015] [Accepted: 09/08/2015] [Indexed: 01/20/2023]
Abstract
CONTEXT In the absence of randomised controlled trials comparing the oncologic, toxicity, and functional outcomes of salvage radical prostatectomy (SRP), salvage high-intensity focused ultrasound (SHIFU), salvage brachytherapy (SBT), and salvage cryotherapy (SCT), controversy exists as to the optimal salvage modality in radiorecurrent prostate cancer. OBJECTIVE We carried out a meta-regression analysis to determine whether there is a difference in oncologic, toxicity, and functional outcomes using data from original publications of salvage modalities in the postradiation setting. EVIDENCE ACQUISITION We performed a systematic review of PubMed/Medline citations according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. We included 63 articles in the analysis (25 on SRP, 8 on SHIFU, 16 on SCT, 14 on SBT). EVIDENCE SYNTHESIS Median values of the following variables were extracted from each study: patient age, length of follow-up, prostate-specific antigen (PSA) before radiotherapy (RT), PSA before salvage therapy, Gleason score before RT, and time interval between RT and salvage therapy. Functional, toxicity, and oncologic outcomes were measured according to rates of impotence, incontinence, fistula formation, urethral strictures, and biochemical recurrence. Meta-regression adjusting for confounders found no significant difference in oncologic outcomes between SRP and nonsurgical salvage modalities. SBT, SCT, and SHIFU appeared to have better continence outcomes than SRP. No significant difference in toxicity outcomes between modalities was found, although limitations such as reporting, selection, and publication bias and between-study heterogeneity must also be considered with these conclusions. CONCLUSIONS Oncologic outcomes are comparable for SRP and all three nonsurgical salvage modalities. We found no significant differences in toxicity outcomes among modalities; however, SRP appears to be associated with worse rates of urinary incontinence than SBT, SCT, and SHIFU. PATIENT SUMMARY We performed a meta-regression analysis to compare oncologic, functional, and toxicity outcomes between salvage radical prostatectomy and nonsurgical salvage modalities. Oncologic and toxicity outcomes appear to be similar; however, all nonsurgical salvage modalities may be associated with better continence outcomes.
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Affiliation(s)
- Yiannis Philippou
- Department of Surgery, Basildon and Thurrock University Hospital, Essex, UK
| | - Richard A Parker
- Health Services Research Unit University of Edinburgh, Edinburgh, UK
| | - Dimitrios Volanis
- Department of Urology, Addenbrooke's University Hospital, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Addenbrooke's University Hospital, Cambridge, UK; Academic Urology Group, Department of Surgery and Oncology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
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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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