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Richards HS, Cousins S, Scroggie DL, Elliott D, Macefield R, Hudson E, Mutanga IR, Shah M, Alford N, Blencowe NS, Blazeby J. Examining the application of the IDEAL framework in the reporting and evaluation of innovative invasive procedures: secondary qualitative analysis of a systematic review. BMJ Open 2024; 14:e079654. [PMID: 38803251 PMCID: PMC11129025 DOI: 10.1136/bmjopen-2023-079654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The development of new surgical procedures is fundamental to advancing patient care. The Idea, Developments, Exploration, Assessment and Long-term (IDEAL) framework describes study designs for stages of innovation. It can be difficult to apply due to challenges in defining and identifying innovative procedures. This study examined how the IDEAL framework is operationalised in real-world settings; specifically, the types of innovations evaluated using the framework and how authors justify their choice of IDEAL study design. DESIGN Secondary qualitative analysis of a systematic review. DATA SOURCES Citation searches (Web of Science and Scopus) identified studies following the IDEAL framework and citing any of the ten key IDEAL/IDEAL_D papers. ELIGIBILITY CRITERIA Studies of invasive procedures/devices of any design citing any of the ten key IDEAL/IDEAL_D papers. DATA EXTRACTION AND SYNTHESIS All relevant text was extracted. Three frameworks were developed, namely: (1) type of innovation under evaluation; (2) terminology used to describe stage of innovation and (3) reported rationale for IDEAL stage. RESULTS 48 articles were included. 19/48 described entirely new procedures, including those used for the first time in a different clinical context (n=15/48), reported as IDEAL stage 2a (n=8, 53%). Terminology describing stage of innovation was varied, inconsistent and ambiguous and was not defined. Authors justified their choice of IDEAL study design based on limitations in published evidence (n=36) and unknown feasibility and safety (n=32) outcomes. CONCLUSION Identifying stage of innovation is crucial to inform appropriate study design and governance decisions. Authors' rationale for choice of IDEAL stage related to the existing evidence base or lack of sufficient outcome data for procedures. Stage of innovation was poorly defined with inconsistent descriptions. Further work is needed to develop methods to identify innovation to inform practical application of the IDEAL framework. Defining the concept of innovation in terms of uncertainty, risk and degree of evidence may help to inform decision-making.
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Affiliation(s)
- Hollie Sarah Richards
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Darren L Scroggie
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Elizabeth Hudson
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Ian Rodney Mutanga
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Maximilian Shah
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Natasha Alford
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Jane Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
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Light A, Mayor N, Cullen E, Kirkham A, Padhani AR, Arya M, Bomers JGR, Dudderidge T, Ehdaie B, Freeman A, Guillaumier S, Hindley R, Lakhani A, Pendse D, Punwani S, Rastinehad AR, Rouvière O, Sanchez-Salas R, Schoots IG, Sokhi HK, Tam H, Tempany CM, Valerio M, Verma S, Villeirs G, van der Meulen J, Ahmed HU, Shah TT. The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations. Eur Urol 2024; 85:466-482. [PMID: 38519280 DOI: 10.1016/j.eururo.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. METHODS A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. KEY FINDINGS AND LIMITATIONS In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. CONCLUSIONS AND CLINICAL IMPLICATIONS The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. PATIENT SUMMARY Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nikhil Mayor
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Cullen
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Manit Arya
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joyce G R Bomers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Amish Lakhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - Olivier Rouvière
- Department of Vascular and Urinary Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine, Université de Lyon, Lyon, France
| | | | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heminder K Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Henry Tam
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Mohamad O, Nicosia L, Mathier E, Riggenbach E, Zamboglou C, Aebersold DM, Alongi F, Shelan M. Focal brachytherapy as definitive treatment for localized prostate cancer: A systematic review and meta-analysis. Brachytherapy 2024; 23:309-320. [PMID: 38431441 DOI: 10.1016/j.brachy.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/06/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE In this systematic review and meta-analysis, we describe the oncologic and toxicity outcomes of definitive focal brachytherapy for prostate cancer. METHODS AND MATERIALS A PROSPERO registered study (CRD42023410170) was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, and The Cochrane Library were searched for studies between 2000 and 2022. Two authors independently performed the initial search. Biochemical recurrence-free survival (bRFS) was defined as the primary endpoint for the meta-analysis. Generalized linear mixed-effects models were conducted to calculate effect size and quantify heterogeneity. We also describe the side effects and local recurrence patterns of focal brachytherapy. RESULTS Ten studies were identified and included 315 patients treated using focal brachytherapy as a definitive treatment. Mean (SD) age was 67.65 (7.9) years and mean (SD) PSA was 7.15 (2.7) ng/mL. Most patients (n = 236, 75%) underwent LDR Brachytherapy and 25% received HDR brachytherapy. Among the participants, 147 (46.5%) had a Gleason score ≤6, and 169 (53.5%) had a Gleason score ≥7. Only 11 (3.5%) patients received ADT. Overall, bRFS rate at median follow-up 4 years (Range: 1-6.42 years) was 91% (95% confidence interval [CI], 82-95%). Acute Grade ≤ 2 GU and GI toxicities were reported in 22 (7%) and 11 (3.5%) patients, respectively. Late Grade ≤ 2 GU and GI toxicity were reported in 6 (2%) and 14 (4.4%) patients, respectively. One case of prostate hemorrhage due to improper foley removal was noted but otherwise no acute or late Grade 3 or higher GI or GU toxicity related to radiotherapy was reported. CONCLUSION Overall, definitive focal brachytherapy has a favorable toxicity profile. Oncologic outcomes are yet to mature. The evidence is limited by the small number of studies with low patients' number, across study heterogeneity, and possibility of publication bias.
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Affiliation(s)
- Osama Mohamad
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Riggenbach
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fillipo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Is hemi-gland focal LDR brachytherapy as effective as whole-gland treatment for unilateral prostate cancer? Brachytherapy 2022; 21:870-876. [PMID: 36207244 DOI: 10.1016/j.brachy.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/09/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The Hemi-Ablative Prostate Brachytherapy (HAPpy) trial evaluated hemi-gland (HG) low-dose-rate prostate brachytherapy (LDR-PB) as a focal approach to control unilateral localized prostate cancer and reduce treatment-related toxicity at 2-years postimplant. Herewith we present further outcomes with a minimum of 5 years post-implant follow-up. METHODS AND MATERIALS Outcomes of 30 HG implants and 362 whole-gland (WG) brachytherapy controls were monitored with IPSS, urinary Quality-of-Life (QoLU), GI component of EORTC-PR25 (QoLB), and IIEF-5 instruments, and PSA values. The median (range) follow-up for HG and WG cases was 72 (60-96) months and 84 (24-144) months respectively. RESULTS The IPSS was significantly reduced in HG relative to WG patients and trends indicating improved bowel QoL and erectile function were observed. The mean of change in PSA from baseline to last follow-up was -5.6 and -6.5 in HG and WG respectively (p = 0.1). The mean time to nadir was 4.2 and 4.8 years in HG and WG respectively (p = 0.06). Over time PSA in HG patients mirrored the sustained decline observed in WG cases but levels were higher by an average 0.5 ng/ml over WG controls (p < 0.001). Treatment failure occurred in 2 (6.7%) HG patients and in 20 (5.5%) WG cases. Five-year relapse-free survival was 97% in both groups (p = 0.7). CONCLUSIONS At 5 years postimplant HG LDR-PB was as effective as WG treatment for control of unilateral localized prostate cancer with moderate improvement in treatment-related symptoms. Importantly, PSA is a valuable marker to assess disease control in this form of focal therapy.
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Matsuoka Y, Uehara S, Toda K, Fukushima H, Tanaka H, Yoshida S, Yokoyama M, Yoshimura R, Kihara K, Fujii Y. Focal brachytherapy for localized prostate cancer: 5.7-year clinical outcomes and a pair-matched study with radical prostatectomy. Urol Oncol 2021; 40:161.e15-161.e23. [PMID: 34895818 DOI: 10.1016/j.urolonc.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/09/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To report experience with focal brachytherapy (FB) and compare its clinical outcomes with those of radical prostatectomy (RP) in localized prostate cancer. METHODS Fifty-one patients with low- to intermediate-risk prostate cancer underwent low-dose-rate FB. Survival rates free from biochemical failure (BF), additional treatment (AT) including re-FB, and whole-gland or systemic salvage therapy (ST) were calculated and oncological risk factors were investigated. Patient-reported outcomes on genitourinary function were also assessed. Using propensity scoring, 51 pair-matched RP patients were selected. Oncological control, urinary continence, and ejaculation status after FB and RP were compared. RESULTS During a median 5.7-year follow-up, BF, AT, and ST occurred in 12 (24%), 10 (20%), and 4 FB patients (8%), respectively. 6 of 10 AT patients were managed with re-FB alone. In the RP cohort, 3 patients (6%) underwent ST. 5-year BF-free survival rate after FB was 79%. Compared to 5-year ST-free survival rate of 94% after RP, ST-free and AT-free survival rates after FB were 93% (P = 0.813) and 87% (P = 0.049), respectively. Multivariate analyses of FB-treated patients showed that time to PSA nadir was negatively associated with BF and AT (hazard ratio 0.84 and 0.83, respectively, P <0.001 for each). The difference in oncological outcomes between low- and intermediate-risk categories was not significant. At 2 years after FB and RP, pad-free continence rates were 100% and 81%, respectively (P = 0.001). Ejaculation was preserved in 67% and 0% of patients who had been capable of ejaculation at baseline, respectively (P <0.001). CONCLUSION In low- to intermediate-risk prostate cancer, FB-treated patients achieved superior genitourinary function compared to pair-matched RP patients. The need for ST was not substantially different between the 2 treatment cohorts. Over half of patients requiring AT could be managed by re-focal treatment rather than whole-gland ST. Early PSA nadir may predict poor oncological control after FB.
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Affiliation(s)
- Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuma Toda
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Anderson E, Smyth LML, O'Sullivan R, Ryan A, Lawrentschuk N, Grummet J, See AW. Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution. Transl Androl Urol 2021; 10:3591-3603. [PMID: 34733655 PMCID: PMC8511546 DOI: 10.21037/tau-21-508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Abstract
Background Focal treatment for prostate cancer (PCa) is a hybrid approach combining ablative treatment of the involved prostate gland and continued active surveillance (AS) of the unaffected gland. Low dose-rate (LDR) brachytherapy can be used as a lesion-targeted focal therapy, however, further studies are required to support its use. The aim of this study is to evaluate the dosimetry, toxicity and oncological outcomes of men receiving lesion-targeted focal LDR brachytherapy for low to intermediate risk PCa. Methods This is a retrospective cohort study of 26 men with unifocal, low to intermediate grade PCa diagnosed on a combination of multiparametric-magnetic resonance imaging (mp-MRI) and targeted plus template transperineal (TP) biopsy, who received focal LDR brachytherapy at a single institution. Brachytherapy involved a single monotherapy implant using iodine-125 seeds to deliver a prescribed dose of 145 Gy to the index lesion. Results The mean focal planning target volume (F-PTV) as a percentage of the prostate volume was 24.5%. The percentage of the focal gross tumour volume (F-GTV) receiving 100% of the prescription dose was 100% for 12 patients and ≥98% for 18 patients. The median follow-up for toxicity and biochemical control outcomes was 23.1 [interquartile range (IQR) 19.1–31.3] and 24.2 (IQR 17.9–30.0) months, respectively. Grade 2 urinary and erectile toxicities were reported by 29.2% and 45.8% of patients, respectively, with resolution of urinary symptoms to baseline by last follow-up. There were no grade ≥3 urinary or erectile toxicities or grade ≥2 rectal toxicity. All 21 patients who underwent a repeat mp-MRI and TP biopsy at 12–24 months post-treatment were negative for clinically significant disease and 25 (96.2%) patients were free from biochemical failure (FFBF). Conclusions Focal LDR brachytherapy is associated with a favourable toxicity profile and a high rate of control of significant PCa at 12–18 months post-treatment. We have commenced the LIBERATE prospective registry in focal LDR brachytherapy based on the highly encouraging outcomes of this initial experience.
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Affiliation(s)
- Elliot Anderson
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Richard O'Sullivan
- Healthcare Imaging Services, Richmond, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Andrew Ryan
- TissuPath Specialist Pathology Services, Mount Waverley, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia.,EJ Whitten Centre for Prostate Cancer Research, Epworth Healthcare, Melbourne, Australia
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.,Epworth Healthcare, Richmond, Australia
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van Luijtelaar A, Fütterer JJ, Bomers JG. Minimally invasive magnetic resonance image-guided prostate interventions. Br J Radiol 2021; 95:20210698. [PMID: 34723623 PMCID: PMC8978246 DOI: 10.1259/bjr.20210698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Whole gland prostate cancer treatment, i.e. radical prostatectomy or radiation therapy, is highly effective but also comes with a significant impact on quality of life and possible overtreatment in males with low to intermediate risk disease. Minimal-invasive treatment strategies are emerging techniques. Different sources of energy are used to aim for targeted treatment in order to reduce treatment-related complications and morbidity. Imaging plays an important role in targeting and monitoring of treatment approaches preserving parts of the prostatic tissue. Multiparametric magnetic resonance imaging (mpMRI) is widely used during image-guided interventions due to the multiplanar and real-time anatomical imaging while providing an improved treatment accuracy. This review evaluates the available image-guided prostate cancer treatment options using MRI or magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion guided imaging. The discussed minimal invasive image-guided prostate interventions may be considered as safe and feasible partial gland ablation in patients with (recurrent) prostate cancer. However, most studies focusing on minimally invasive prostate cancer treatments only report early stages of research and subsequent high-level evidence is still needed. Ensuring a safe and appropriate utilization in patients that will benefit the most, and applied by physicians with relevant training, has become the main challenge in minimally invasive prostate cancer treatments.
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Affiliation(s)
- Annemarijke van Luijtelaar
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joyce Gr Bomers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Fiard G, Chowdhury A, Potter AR, Pook CJ, Kelly D, Emberton M, Yap T. Detailing Sexual Outcomes After Focal Therapy for Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2021; 8:926-941. [PMID: 34580049 DOI: 10.1016/j.euf.2021.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/04/2021] [Accepted: 09/10/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field. OBJECTIVE We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research. EVIDENCE ACQUISITION A systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the "litsearchr" function in R based on a preliminary "naïve" search using the following terms on Medline: (("focal therapy" OR "focal treatment") AND ("prostate cancer") AND ("sexual function" OR "erectile function")). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis. EVIDENCE SYNTHESIS The five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18-24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate -3.70 [95% confidence interval -4.43, -2.96]), with improvements at 6 mo (-2.18 [-2.91, -1.46]) and 12 mo (-2.14 [-2.96, -1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered. CONCLUSIONS Focal therapy led to changes in erectile function in most cases under the significance threshold of the patient-reported outcome questionnaires used. However, patients should be counselled according to their baseline erectile function. More research is warranted to detail aspects other than erectile function, such as ejaculation or orgasm. The early postoperative period appears key to study sexual changes after focal therapy, while only a moderate decrease is expected at 12 mo. PATIENT SUMMARY We reviewed the published literature detailing the sexual consequences of focal therapy for localised prostate cancer using patient-reported outcome questionnaires. Patients were likely to describe a significant decrease in their erectile function at 3 mo, with improvements noted at 6 and 12 mo. The results obtained may not be reproducible in a more diverse population, and further research is warranted to better study aspects other than erectile function, such as ejaculation or orgasm.
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Affiliation(s)
- Gaelle Fiard
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
| | - Aminah Chowdhury
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Aneirin R Potter
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Celina J Pook
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tet Yap
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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9
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Hopstaken JS, Bomers JGR, Sedelaar MJP, Valerio M, Fütterer JJ, Rovers MM. An Updated Systematic Review on Focal Therapy in Localized Prostate Cancer: What Has Changed over the Past 5 Years? Eur Urol 2021; 81:5-33. [PMID: 34489140 DOI: 10.1016/j.eururo.2021.08.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/12/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Focal therapy is a promising, minimally invasive strategy to selectively treat localized prostate cancer. A previous systematic review indicated that there is growing evidence for favorable functional outcomes, but that oncological effectiveness was yet to be defined. OBJECTIVE To assess the effectiveness of focal therapy in patients with localized prostate cancer in terms of functional and oncological outcomes. EVIDENCE ACQUISITION PubMed, Embase, and The Cochrane Library were searched for studies between October 2015 and December 31, 2020. In addition, the research stages were acquired according to the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) recommendations. Ongoing studies were identified through clinical trial registries. EVIDENCE SYNTHESIS Seventy-two studies were identified exploring eight different sources of energy to deliver focal therapy in 5827 patients. Twenty-seven studies reported on high-intensity focused ultrasound (HIFU), nine studies on irreversible electroporation, 11 on cryoablation, eight on focal laser ablation and focal brachytherapy, seven on photodynamic therapy (PDT), two on radiofrequency ablation, and one on prostatic artery embolization. The majority of studies were prospective development stage 2a studies (n = 35). PDT and HIFU, both in stage 3, showed promising results. Overall, HIFU studies reported a median of 95% pad-free patients and a median of 85% patients with no clinically significant cancer (CSC) in the treated area. For PDT, no changes in continence were reported and a median of 90% of patients were without CSC. Both treatments were well tolerated. CONCLUSIONS Over the past 5 yr, focal therapy has been studied for eight different energy sources, mostly in single-arm stage 2 studies. Although a first randomized controlled trial in focal therapy has been performed, more high-quality evaluations are needed, preferably via multicenter randomized controlled trials with long-term follow-up and predefined assessment of oncological and functional outcomes and health-related quality-of-life measures. PATIENT SUMMARY Focal treatment (FT) of prostate cancer has potential, considering that it has less impact on continence and potency than radical treatment. Our systematic review indicates that despite the method being studied extensively over the past half decade, the majority of studies remain in an early research stage. The techniques high-intensity focused ultrasound and photodynamic therapy have shown most progression toward advanced research stages and show favorable results. However, more high-quality evidence is required before FT can become available as a standard treatment.
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Affiliation(s)
- Jana S Hopstaken
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Joyce G R Bomers
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel J P Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jurgen J Fütterer
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Barry Delongchamps N, Schull A, Anract J, Abecassis JP, Zerbib M, Sibony M, Jilet L, Abdoul H, Goffin V, Peyromaure M. Feasibility and safety of targeted focal microwave ablation of the index tumor in patients with low to intermediate risk prostate cancer: Results of the FOSTINE trial. PLoS One 2021; 16:e0252040. [PMID: 34260598 PMCID: PMC8279354 DOI: 10.1371/journal.pone.0252040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the feasibility, safety and precision of organ-based tracking (OBT)-fusion targeted focal microwave ablation (FMA), in patients with low to intermediate risk prostate cancer. PATIENTS AND METHOD Ten patients with a visible index tumor of Gleason score ≤3+4, largest diameter <20mm were included. Transrectal OBT-fusion targeted FMA was performed using an 18G needle. Primary endpoint was the evidence of complete overlap of the index tumor by ablation zone necrosis on MRI 7 days after ablation. Urinary and sexual function were assessed with IPSS, IIEF5 and MSHQ-EjD-SF. Oncological outcomes were assessed with PSA at 2 and 6 months, and re-biopsy at 6 months. RESULTS Median [IQR] age was 64.5 [61-72] years and baseline PSA was 5 [4.3-8.1] ng/mL. Seven (70%) and 3 (30%) patients had a low and intermediate risk cancer, respectively. Median largest tumor axis was of 11 [9.0-15.0] mm. Median duration of procedure was of 82 [44-170] min. No patient reported any pain or rectal bleeding, and all 10 patients were discharged the next day. Seven days after ablation, total necrosis of the index tumor on MRI was obtained in eight (80% [95%CI 55%-100%]) patients. One patient was treated with radical prostatectomy. Re-biopsy at 6 months in the other 9 did not show evidence of cancer in 4 patients. IPSS, IIEF-5 and MSHQ-EjD-SF were not statistically different between baseline and 6 months follow up. CONCLUSIONS OBT-fusion targeted FMA was feasible, precise, and safe in patients with low to intermediate risk localized prostate cancer.
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Affiliation(s)
- Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | - Alexandre Schull
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Julien Anract
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | | | - Marc Zerbib
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Mathilde Sibony
- Department of Pathology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Léa Jilet
- Clinical Research Unit, Cochin hospital, APHP, Paris Descartes University, Paris, France
| | - Hendy Abdoul
- Clinical Research Unit, Cochin hospital, APHP, Paris Descartes University, Paris, France
| | - Vincent Goffin
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | - Michaël Peyromaure
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
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11
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Saito K, Matsuoka Y, Toda K, Yoshida S, Yokoyama M, Yoshimura R, Kihara K, Fujii Y. Medium-term oncological and functional outcomes of hemi-gland brachytherapy using iodine-125 seeds for intermediate-risk unilateral prostate cancer. Brachytherapy 2021; 20:842-848. [PMID: 33883093 DOI: 10.1016/j.brachy.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine medium-term outcomes of hemi-gland low-dose-rate brachytherapy as a primary treatment for intermediate-risk prostate cancer. METHODS We recruited intermediate-risk unilateral prostate cancer patients for a prospective trial of hemi-gland brachytherapy. Twenty-four patients underwent hemi-gland iodine-125 seed implantation with a prescribed dose of 160 Gy. Serum prostate-specific antigen (PSA) was measured regularly and follow-up biopsy was scheduled after 2-3 years of treatment. When clinically needed afterward, for-cause biopsy was performed to confirm pathology. Treatment failure (TF)-free survival, which was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality, was assessed, as was biochemical failure (BF)-free survival. Urinary and sexual functions were also evaluated. RESULTS Median follow-up duration was 61 months. Twenty-two patients (92%) exhibited a declining trend or decreased value of PSA for 12 months or longer after the treatment. Follow-up biopsy in the initial triennium and for-cause biopsy in the subsequent triennium were performed in 16 and four patients, respectively, and cancer was found from the treated lobe in one patient (4% of the cohort) and significant cancer was found from untreated lobes in four patients (17%) in total. Secondary treatments were performed in six patients successfully. Five-year freedom from BF, TF, and metastasis was 71%, 90%, and 100%, respectively. The International Prostate Symptom Score significantly deteriorated at 3 months and reversed itself afterward. The International Index of Erectile Function 5 had no significant decrease. CONCLUSIONS Hemi-gland low-dose-rate brachytherapy provides favorable medium-term oncological outcomes with genito-urinary functional preservation for men with intermediate-risk unilateral prostate cancer.
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Affiliation(s)
- Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
| | - Kazuma Toda
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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12
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Focal low-dose-rate prostate brachytherapy for low- and intermediate-risk prostate cancer. J Contemp Brachytherapy 2021; 12:554-561. [PMID: 33437303 PMCID: PMC7787206 DOI: 10.5114/jcb.2020.101688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose To prospectively investigate the efficacy and feasibility of focal low-dose-rate (LDR) prostate brachytherapy for low- and intermediate-risk prostate cancer. Material and methods Between October 2014 and May 2019, nineteen low- and intermediate-risk prostate cancer patients who presented with abnormality on both diffusion-weighted and T2-weighted magnetic resonance imaging (MRI) underwent focal LDR brachytherapy at our institution. Focal gross tumor volume (F-GTV) was delineated on transrectal ultrasound, based on abnormality seen on fused T2-weighted MRI. F-GTV was expanded by 5 mm, as a safety margin, to create focal clinical target volume (F-CTV). Prescribed dose to F-CTV was 145 Gy. Biochemical recurrence (BCR) was determined using Phoenix criterion (prostate specific antigen nadir + 2 ng/ml). Pre- and post-implant dosimetry data were compared using non-parametric Wilcoxon’s rank sum test. Treatment-related toxicities were evaluated using common terminology criteria for adverse events. Results Mean F-CTV D90% was significantly lower in the post-implant evaluation than in intraoperative planning (p = 0.004). On post-implant dosimetry, the mean D90% for F-GTV and mean V100% for the entire prostate were 222 Gy and 35%, respectively. Median follow-up time for all patients was 31 months. BCR occurred in one patient after 23 months. Kaplan-Meier 2-year BCR-free rate was 92.9% (95% confidence interval [CI]: 79.4-100%). No patients had grade 1 or greater gastrointestinal toxicity. Three patients who were taking α-blockers to treat benign prostatic hyperplasia (present before brachytherapy), experienced no treatment-related genitourinary toxicities. Two patients suffered from temporary grade 2 urinary frequency. None of the remaining patients experienced grade 2 or higher genitourinary toxicity. Conclusions Focal LDR prostate brachytherapy appears acceptable for MRI-based index tumors, with a low cumulative incidence of BCR. Such brachytherapy might offer a feasible minimally invasive therapeutic option for localized prostate cancer.
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13
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Ta MH, Nunes-Silva I, Barret E, Renard-Penna R, Rozet F, Mombet A, Cathala N, Sanchez-Salas R, Créhange G, Cathelineau X, Cosset JM. Focal Brachytherapy for Localized Prostate Cancer: Midterm Outcomes. Pract Radiat Oncol 2021; 11:e477-e485. [PMID: 33422681 DOI: 10.1016/j.prro.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Focal brachytherapy (F-BT) is a suitable technique for focal therapy in localized prostate cancer. It has the ability to adapt the seed implantation to the volume and location of the tumor. The aim of this study was to assess F-BT oncologic, functional, and toxicity midterm outcomes in men who underwent prostate cancer treatment. METHODS AND MATERIALS The study included 39 men with low- to intermediate-risk prostate cancer treated with F-BT between 2010 and 2015. The dose prescription was 145 Gy. Failure was defined as the presence of any residual prostate cancer in the treated area. The primary and secondary endpoints were the F-BT oncologic and functional outcomes, respectively. A 2-sided P value < .05 indicated statistical significance. RESULTS The mean follow-up time was 65 months (range, 43-104 months). After 24 months, 34 patients underwent control biopsies and 5 patients refused. The biopsies were negative in 27 cases (79%) and positive in 7 cases (21%), all outside the volume treated. Biochemical relapse-free survival at 5 years, disease-free survival, and overall survival were 96.8% ± 0.032%, 79.5% ± 0.076%, and 100%, respectively. The mean International Prostate Symptom Score at 2 months was significantly higher than initially (P = .0003), with no significant difference later. No late urinary, sexual, or rectal toxicity was observed. Salvage treatment was possible with good tolerance at 3.4 years of follow-up. Limitations of this study include the retrospective nature and lack of randomization. CONCLUSIONS F-BT is a safe and effective treatment for selected patients presenting with low- or intermediate-risk localized prostate cancer.
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Affiliation(s)
- Minh-Hanh Ta
- Radiotherapy Department, SNC Charlebourg, Amethyst Group, La Garenne-Colombes, France
| | - Igor Nunes-Silva
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Urology Department, Arnaldo Vieira de Carvalho Cancer Institute, Sao Paulo, Brazil
| | - Eric Barret
- Urology Department, Institut Mutualiste Montsouris, Paris, France.
| | | | - François Rozet
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | - Annick Mombet
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | - Nathalie Cathala
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | | | - Gilles Créhange
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Oncology/Radiotherapy Department, Institut Curie, Paris, France
| | | | - Jean-Marc Cosset
- Radiotherapy Department, SNC Charlebourg, Amethyst Group, La Garenne-Colombes, France; Urology Department, Institut Mutualiste Montsouris, Paris, France; Oncology/Radiotherapy Department, Institut Curie, Paris, France
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14
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Macefield RC, Wilson N, Hoffmann C, Blazeby JM, McNair AGK, Avery KNL, Potter S. Outcome selection, measurement and reporting for new surgical procedures and devices: a systematic review of IDEAL/IDEAL-D studies to inform development of a core outcome set. BJS Open 2020; 4:1072-1083. [PMID: 33016009 PMCID: PMC8444278 DOI: 10.1002/bjs5.50358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Outcome selection, measurement and reporting for the evaluation of new surgical procedures and devices is inconsistent and lacks standardization. A core outcome set may promote the safe and transparent evaluation of surgical innovations. This systematic review examined outcome selection, measurement and reporting in studies conducted within the IDEAL (Idea, Development, Exploration, Assessment and Long-term monitoring) framework to examine current practice and inform the development of a core outcome set for early-phase studies of surgical procedures/devices. METHODS Web of Science and Scopus citation searches were performed to identify author-reported IDEAL/IDEAL-D studies for any surgical procedure/device. Outcomes were extracted verbatim, including contextual information regarding outcome selection and measurement. Outcomes were categorized to inform a conceptual framework of outcome domains relevant to evaluating innovation. RESULTS Some 48 studies were identified. Outcome selection, measurement and reporting varied widely across studies in different IDEAL stages. From 1737 outcomes extracted, 22 domains specific to evaluating innovation were conceptualized under seven broad categories: procedure completion success/failure; modifications; unanticipated events; surgeons' experiences; patients' experiences; resource use specific to the innovative procedure/device; and other innovation-specific outcomes. Most innovation-specific outcomes were measured and reported in only a small number of studies. CONCLUSION This review highlighted the need for guidance and standardization in outcome selection and reporting in the evaluation of new surgical procedures/devices. Novel outcome domains specific to innovation have been identified to establish a core outcome set for future evaluations of surgical innovations.
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Affiliation(s)
- R. C. Macefield
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - N. Wilson
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - C. Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - J. M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - A. G. K. McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
- Department of Gastrointestinal SurgeryBristolUK
| | - K. N. L. Avery
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - S. Potter
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
- Bristol Breast Care CentreNorth Bristol NHS TrustBristolUK
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15
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Fallara G, Capogrosso P, Maggio P, Taborelli A, Montorsi F, Dehò F, Salonia A. Erectile function after focal therapy for localized prostate cancer: a systematic review. Int J Impot Res 2020; 33:418-427. [PMID: 32999435 DOI: 10.1038/s41443-020-00357-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022]
Abstract
Focal therapy modalities achieved interest in the management of prostate cancer (PCa) over the last a few years. This systematic review was aimed to investigate erectile function after focal therapy for localized PCa. Twenty-six out of 1287 reports were identified through a database systematic search in MEDLINE, EMBASE, and Web of Science, supplemented with hand search, on June 1st, 2020, according to PRISMA guidelines. Focal therapy modalities investigated were cryotherapy, high-intensity focused ultrasound (HIFU), photodynamic therapy (TOOKAD), irreversible electroporation (IRE), and focal radiotherapy (RT) (i.e. brachytherapy or stereotactic RT). Overall, reported sexual function outcomes after these treatment modalities were generally good, with many studies reporting a complete recovery of EF at 1-year follow-up. However, the quality of current evidence is affected both by the lack of well-conducted comparative studies and by a significant heterogeneity in terms of study design, study population, erectile and sexual function assessment modalities.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy.
| | - Paolo Maggio
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy
| | - Alessandro Taborelli
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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16
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Abstract
Modern cancer treatment aims to conserve as much healthy tissue as possible. This has been challenging in the treatment of prostate cancer due to the difficulty in imaging the gland and concerns over leaving multifocal cancer untreated. With improvements in imaging and understanding of multifocal prostate cancer evidence now shows accurate treatment of just the primary focus of cancer or the index lesion can control progression or recurrence of the disease. Many different energy sources are now available to target the cancer lesion within the prostate with less significant side-effects on urinary and sexual function compared to radical treatment. Evidence shows that men value these functions highly and would even trade years of life in exchange for preserved retention of continence or erectile function. Focal treatment of prostate cancer aims to provide both cancer control and preservation of sexual and urinary functions so that men do not have to make a choice between the two. This is a treatment option that men clearly want and deserve.
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Affiliation(s)
- Nishant Bedi
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Deepika Reddy
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hashim U Ahmed
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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17
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Tourinho-Barbosa RR, Wood BJ, Abreu AL, Nahar B, Shin T, Guven S, Polascik TJ. Current state of image-guided focal therapy for prostate cancer. World J Urol 2020; 39:701-717. [PMID: 32444886 DOI: 10.1007/s00345-020-03254-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/11/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa). METHODS A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review. RESULTS Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3-5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare. CONCLUSION An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.
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Affiliation(s)
- Rafael R Tourinho-Barbosa
- Department of Urology, Hospital CardioPulmonar, 157, Ponciano Oliveira Street, Salvador, Bahia, 40170-530, Brazil.
- Department of Urology, Faculdade de Medicina Do ABC (ABC Medical School), São Paulo, Brazil.
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Interventional Radiology, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD, USA
| | - Andre Luis Abreu
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Toshitaka Shin
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
| | - Selcuk Guven
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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18
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Peters M, van Son MJ, Moerland MA, Kerkmeijer LGW, Eppinga WSC, Meijer RP, Lagendijk JJW, Shah TT, Ahmed HU, van der Voort van Zijp JRN. MRI-Guided Ultrafocal HDR Brachytherapy for Localized Prostate Cancer: Median 4-Year Results of a feasibility study. Int J Radiat Oncol Biol Phys 2019; 104:1045-1053. [PMID: 30926575 DOI: 10.1016/j.ijrobp.2019.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE For the treatment of localized prostate cancer, focal therapy has the potential to cure with fewer side effects than traditional whole-gland treatments. We report an update on toxicity, quality of life (QoL), and tumor control in our magnetic resonance imaging (MRI)-guided ultrafocal high-dose-rate brachytherapy cohort. METHODS AND MATERIALS Disease status was evaluated by systematic biopsies and 3T multiparametric MRI. The brachytherapy implant procedure under fused transrectal ultrasound/MRI guidance was followed by a 1.5 T MRI for contour adjustments and catheter position verification. A single dose of 19 Gy was delivered to the tumor with a margin of 5 mm. Genitourinary (GU) toxicity, gastrointestinal (GI) toxicity, and erectile dysfunction (ED) were graded with the Common Terminology Criteria for Adverse Events version 4.0. QoL was measured with RAND-36, European Organisation for Research and Treatment of Cancer QLQ-C30 and PR25. International Prostate Symptom Scores and International Index of Erectile Function scores were obtained. Prostate-specific antigen level was monitored, with biochemical recurrence defined as nadir + 2 ng/mL (Phoenix). RESULTS Thirty patients with National Comprehensive Cancer Network low- (13%) to intermediate-risk (87%) prostate cancer were treated between May 2013 and April 2016. Median follow-up was 4 years. Median age was 71 years (interquartile range, 68-73) and median initial prostate-specific antigen level was 7.3 ng/mL (5.2-8.1). Maximum Gleason score was 4 + 3 = 7 (in 2 patients). All tumors were radiologic (MRI) stage T2. No grade >2 GU or >1 GI toxicity occurred. International Prostate Symptom Scores only deteriorated temporarily. Mild pretreatment ED deteriorated to moderate/severe ED in 50% of patients. Long-term clinically relevant QoL deterioration was seen in sexual activity and tiredness, whereas emotional and cognitive functioning improved. At 4 years, biochemical disease-free survival was 70% (95% confidence interval, 52%-93%), metastases-free survival was 93% (85%-100%), and overall survival was 100%. Of intraprostatic recurrences, 7 of 9 were out of field. CONCLUSIONS Ultrafocal high-dose-rate brachytherapy conveys minimal GU or GI toxicity and has a marginal effect on QoL. An early decline in erectile function was seen. Tumor control outcomes are poor (biochemical disease-free survival of 70% [52%-93%] at 4 years), most likely as a result of poor patient selection.
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Affiliation(s)
- Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Marieke J van Son
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marinus A Moerland
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wietse S C Eppinga
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, Netherlands; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jan J W Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Taimur T Shah
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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