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Tay KJ, Scheltema MJ, Ahmed HU, Barret E, Coleman JA, Dominguez-Escrig J, Ghai S, Huang J, Jones JS, Klotz LH, Robertson CN, Sanchez-Salas R, Scionti S, Sivaraman A, de la Rosette J, Polascik TJ. Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project. Prostate Cancer Prostatic Dis 2017; 20:294-299. [PMID: 28349978 DOI: 10.1038/pcan.2017.8] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/14/2017] [Accepted: 01/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whole-gland extirpation or irradiation is considered the gold standard for curative oncological treatment for localized prostate cancer, but is often associated with sexual and urinary impairment that adversely affects quality of life. This has led to increased interest in developing therapies with effective cancer control but less morbidity. We aimed to provide details of physician consensus on patient selection for prostate focal therapy (FT) in the era of contemporary prostate cancer management. METHODS We undertook a four-stage Delphi consensus project among a panel of 47 international experts in prostate FT. Data on three main domains (role of biopsy/imaging, disease and patient factors) were collected in three iterative rounds of online questionnaires and feedback. Consensus was defined as agreement in ⩾80% of physicians. Finally, an in-person meeting was attended by a core group of 16 experts to review the data and formulate the consensus statement. RESULTS Consensus was obtained in 16 of 18 subdomains. Multiparametric magnetic resonance imaging (mpMRI) is a standard imaging tool for patient selection for FT. In the presence of an mpMRI-suspicious lesion, histological confirmation is necessary prior to FT. In addition, systematic biopsy remains necessary to assess mpMRI-negative areas. However, adequate criteria for systematic biopsy remains indeterminate. FT can be recommended in D'Amico low-/intermediate-risk cancer including Gleason 4+3. Gleason 3+4 cancer, where localized, discrete and of favorable size represents the ideal case for FT. Tumor foci <1.5 ml on mpMRI or <20% of the prostate are suitable for FT, or up to 3 ml or 25% if localized to one hemi-gland. Gleason 3+3 at one core 1mm is acceptable in the untreated area. Preservation of sexual function is an important goal, but lack of erectile function should not exclude a patient from FT. CONCLUSIONS This consensus provides a contemporary insight into expert opinion of patient selection for FT of clinically localized prostate cancer.
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Affiliation(s)
- K J Tay
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - M J Scheltema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College of London, London, UK
| | - E Barret
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - J A Coleman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - S Ghai
- University of Toronto, Toronto, ON, Canada
| | - J Huang
- Department of Pathology, Duke University, Durham, NC, USA
| | - J S Jones
- Cleveland Clinic, Cleveland, OH, USA
| | - L H Klotz
- Sunnybrook Medical Center, Toronto, ON, Canada
| | - C N Robertson
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - R Sanchez-Salas
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - S Scionti
- Saratosa Prostate Cancer Center, Sarasota, FL, USA
| | - A Sivaraman
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - J de la Rosette
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - T J Polascik
- Duke Cancer Institute, Duke University, Durham, NC, USA
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Scheltema MJ, Tay KJ, Postema AW, de Bruin DM, Feller J, Futterer JJ, George AK, Gupta RT, Kahmann F, Kastner C, Laguna MP, Natarajan S, Rais-Bahrami S, Rastinehad AR, de Reijke TM, Salomon G, Stone N, van Velthoven R, Villani R, Villers A, Walz J, Polascik TJ, de la Rosette JJMCH. Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project. World J Urol 2016; 35:695-701. [PMID: 27637908 PMCID: PMC5397427 DOI: 10.1007/s00345-016-1932-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT). Methods An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results. Results mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers. Conclusions The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1932-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J Scheltema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
| | - K J Tay
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A W Postema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - J Feller
- Desert Medical Imaging, Indian Wells, CA, USA
| | - J J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - R T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel and Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cambridge University Hospitals Trust, Cambridge, UK
| | - M P Laguna
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Natarajan
- Department of Urology, Surgery and Bioengineering, University of California, Los Angeles, CA, USA
| | - S Rais-Bahrami
- Department of Urology and Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - A R Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T M de Reijke
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - N Stone
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R van Velthoven
- Department of Urology, Institut Jules Bordet, Brussels, Belgium
| | - R Villani
- Department of Radiology, North Shore University Hospital, Northwell Health, NY, USA
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - T J Polascik
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Hansen M, Scheltema MJ, Sonne DP, Hansen JS, Sperling M, Rehfeld JF, Holst JJ, Vilsbøll T, Knop FK. Effect of chenodeoxycholic acid and the bile acid sequestrant colesevelam on glucagon-like peptide-1 secretion. Diabetes Obes Metab 2016; 18:571-80. [PMID: 26888164 DOI: 10.1111/dom.12648] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/09/2015] [Accepted: 02/11/2016] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the effects of the primary human bile acid, chenodeoxycholic acid (CDCA), and the bile acid sequestrant (BAS) colesevelam, instilled into the stomach, on plasma levels of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide, glucose, insulin, C-peptide, glucagon, cholecystokinin and gastrin, as well as on gastric emptying, gallbladder volume, appetite and food intake. METHODS On four separate days, nine patients with type 2 diabetes, and 10 matched healthy control subjects received bolus instillations of (i) CDCA, (ii) colesevelam, (iii) CDCA + colesevelam or (iv) placebo. At baseline and for 180 min after instillation, blood was sampled. RESULTS In both the type 2 diabetes group and the healthy control group, CDCA elicited an increase in GLP-1 levels compared with colesevelam, CDCA + colesevelam and placebo, respectively (p < 0.05). The interventions did not affect plasma glucose, insulin or C-peptide concentrations in any of the groups. CDCA elicited a small increase in plasma insulin : glucose ratio compared with colesevelam, CDCA + colesevelam and placebo in both groups. Compared with colesevelam, CDCA + colesevelam and placebo, respectively, CDCA increased glucagon and delayed gastric emptying in both groups. CONCLUSIONS CDCA increased GLP-1 and glucagon secretion, and delayed gastric emptying. We speculate that bile acid-induced activation of TGR5 on L cells increases GLP-1 secretion, which, in turn, may result in amplification of glucose-stimulated insulin secretion. Furthermore our data suggest that colesevelam does not have an acute effect on GLP-1 secretion in humans.
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Affiliation(s)
- M Hansen
- Center for Diabetes Research, Gentofte Hospital, University Copenhagen, Hellerup, Denmark
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University Copenhagen, Copenhagen, Denmark
| | - M J Scheltema
- Center for Diabetes Research, Gentofte Hospital, University Copenhagen, Hellerup, Denmark
- Department of Endocrinology and Metabolism, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - D P Sonne
- Center for Diabetes Research, Gentofte Hospital, University Copenhagen, Hellerup, Denmark
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University Copenhagen, Copenhagen, Denmark
| | - J S Hansen
- Department of Clinical Biochemistry, University Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - M Sperling
- Center for Diabetes Research, Gentofte Hospital, University Copenhagen, Hellerup, Denmark
| | - J F Rehfeld
- Department of Clinical Biochemistry, University Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - J J Holst
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University Copenhagen, Copenhagen, Denmark
| | - T Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University Copenhagen, Hellerup, Denmark
| | - F K Knop
- Center for Diabetes Research, Gentofte Hospital, University Copenhagen, Hellerup, Denmark
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University Copenhagen, Copenhagen, Denmark
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