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

Abstract

BackgroundFocal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field.ObjectiveTo gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design.Design, setting, and participantsFifteen 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 analysisAgreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level.Results and limitationsOf 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging–targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5 mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3 + 3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus.ConclusionsThe 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 summaryIn this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer.

Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes

“…Currently, the consensus definition states that FT is ''any approach able to preserve part of the prostatic tissue, whether by targeted ablation, hemiablation and zonal 'hockey stick' ablation'' [10,11]. Clinically acceptable cancer control following FT is generally agreed for retreatment rates of 20% [12]. The goal of FT is to achieve ''trifecta'' outcomes: cancer control, fewer complications, and preservation of genitourinary function comparable to radical treatment options.…”

New and Established Technology in Focal Ablation of the Prostate: A Systematic Review

“…For instance, although focal therapy has been lately defined as ablation of the index lesion only by a group of experts, there was intra-and inter-study variability in the ablation strategy with many early series using pragmatic template -such as hemiablation (49).Also, in the case of lesion-only ablation, the location of the tumor has a great impact on functional outcomes, especially the distance from the sphincter and neurovascular bundles is likely to influence continence and potency, respectively.…”

834 Standardization in definitions in focal therapy for prostate cancer: Report from a Delphi consensus project

“…Five years later, we formulated the aim of FT to be the eradication of all identifiable significant tumor(s). The consensus project described by Donaldson et al [40] stated that FT should be the treatment of the dominant lesion or index lesion. They add that quadrant ablation could be a FT strategy but with lower level of consensus than lesion ablation only.…”