Guidelines of guidelines: focal therapy for prostate cancer, is it time for consensus?

Ong, Sean; Chen, Kenneth; Grummet, Jeremy; Yaxley, John; Scheltema, Matthijs J.; Stricker, Phillip D.; Tay, Kae Jack; Lawrentschuk, Nathan

doi:10.1111/bju.15883

Cited by 15 publications

(18 citation statements)

References 31 publications

(66 reference statements)

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“…Absence of csPCa on 18‐month MRGB was considered an intermediate‐term success, after which patients were included in an ongoing active surveillance program described previously. Small amounts of GG1 (<6 mm) were not considered csPCa 22,23 …”

Section: Methodsmentioning

confidence: 99%

“…Small amounts of GG1 (<6 mm) were not considered csPCa. 22,23 Patients found to have csPCa on either follow-up biopsy were considered to have reached a study endpoint at which time the men underwent surgery, radiation, repeat PGA, 24 or expectant management (Figure 1). Serum PSA levels were obtained at baseline and throughout the follow-up period.…”

Section: Lay Summarymentioning

confidence: 99%

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Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

et al. 2023

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Background Partial gland ablation (PGA) is a new option for treatment of prostate cancer (PCa). Cryotherapy, an early method of PGA, has had favorable evaluations, but few studies have employed a strict protocol using biopsy endpoints in men with clinically significant prostate cancer (csPCa). Methods 143 men with unilateral csPCa were enrolled in a prospective, observational trial of outpatient PGA‐cryotherapy. Treatment was a 2‐cycle freeze of the affected prostate part. Participants were evaluated with MRI‐guided biopsy (MRGB) at baseline and at 6 months and 18 months after treatment. Absence of csPCa upon MRGB was the primary endpoint; quality‐of‐life at baseline and at 6 months after treatment was assessed by EPIC‐CP questionnaires in the domains of urinary and sexual function. Results Of the 143 participants, 136 (95%) completed MRGB at 6 months after treatment. In 103/136 (76%), the biopsy revealed no csPCa. Of the 103, 71 subsequently had an 18‐month comprehensive biopsy; of the 71 with 18‐month biopsies, 46 (65%) were found to have no csPCa. MRI lesions became undetectable in 96/130 (74%); declines in median serum PSA levels (6.9 to 2.5 ng/mL), PSA density (0.15 to 0.07), and prostate volume (42 to 34cc) were observed (all p < 0.01). Neither lesion disappearance on MRI nor PSA decline correlated with biopsy outcome. Urinary function was affected only slightly and sexual function moderately. Conclusion In the near to intermediate term, partial gland ablation with cryotherapy was found to be a safe and moderately effective treatment of intermediate‐risk prostate cancer. Eradication of cancer was better determined by MRI‐guided biopsy than by MRI or PSA.

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Section: Methodsmentioning

confidence: 99%

Section: Lay Summarymentioning

confidence: 99%

Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

et al. 2023

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“…In this study, a Gleason score of 4 + 3 or less was considered the main indication for treatment, while a score of 4 + 4 with diameters of 10 mm or less were indicated for treatment based on the patient’s general condition. In a previous review of the consensus of inclusion criteria for focal therapy, almost all studies agreed that focal therapy should be reserved for men with a Gleason score less than 4 + 3; however, selected statements did not reach a consensus in patients with a Gleason score of 4 + 4 [ 16 ]. Therefore, the present inclusion criteria were similar to those of other clinical studies on focal therapy, and the present results are expected to be adapted for other clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Severe Erectile Dysfunction after Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer

et al. 2022

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The present study aimed to analyze the effect of predisposing clinical factors for severe erectile dysfunction (ED) in patients treated with focal therapy using high-intensity focused ultrasound (HIFU) for localized prostate cancer (PC). Patients without severe ED (International Index of Erectile Function-5 [IIEF-5] score ≥ 8) before focal HIFU therapy were included. A total of 92 of the 240 patients met the inclusion criteria and were included. The rate of severe ED (IIEF-5 ≤ 7) was 36% 12 months after treatment. Multivariable logistic regression analysis showed that the pre-procedural lower IIEF-5 score (odds ratio [OR] 0.812, p = 0.005), the pre-procedural lower score of the sexual domain of the Expanded Prostate Cancer Index Composite (OR 0.960, p = 0.038), and the treatment of the edge of the peripheral zone (PZ) in proximity to the neurovascular bundle (NVB) [treated vs. untreated, OR 8.048, p = 0.028] were significant risk factors for severe ED at 12 months after treatment. In conclusion, pre-procedural lower erectile function and treatment of the part in proximity to the NVB were significant risk factors for severe ED after focal therapy.

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“…Over the last decade, at least 10 consensuses on FT have been published, covering a range of topics such as definitions, patient selection, biomarker use, and follow-up protocols [ 51 ]. However, many of these consensuses had relatively small respondent pools, with less than 100 people participating, and a majority of these respondents being urologists and experts on the field.…”

Section: Consensus As a Strong Movement To Unify Criteriamentioning

confidence: 99%

Revisiting Delphi to Create a Basis for the Future of Focal Therapy for Prostate Cancer

Rodríguez-Sánchez,

Emberton,

de Reijke

et al. 2024

World J Mens Health

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Guidelines of guidelines: focal therapy for prostate cancer, is it time for consensus?

Abstract: To provide a summary and discussion of international guidelines, position statements and consensus statements in relation to focal therapy (FT) for prostate cancer (PCa).

Cited by 15 publications

References 31 publications

Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

Risk Factors for Severe Erectile Dysfunction after Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer

Revisiting Delphi to Create a Basis for the Future of Focal Therapy for Prostate Cancer

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