Making a case “against” focal therapy for intermediate-risk prostate cancer

Marra, Giancarlo; Teber, Doğu; Shariat, Shahrokh F.; Albayrak, Selami; Coelho, Rafael; Tanguay, Simon; Konety, Badrinath R.

doi:10.1007/s00345-020-03303-y

Cited by 8 publications

(4 citation statements)

References 66 publications

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“…Newly trained urologic oncologists may be driving increased adoption. In addition, increased utilization may be due to strong acceptance of the index lesion theory, as belief signi cantly increased from the previous survey (11)(12)(13). However, it remains to be seen if stronger belief in the index lesion theory is driving increased adoption rates, or if the emerging success of FT and viable short-and intermediate-term oncological outcomes are increasing support of the index lesion theory (4,14).…”

Section: Discussionmentioning

confidence: 95%

Shifting Tides: A Survey Analysis of Urologists' Evolving Attitudes and Practice Patterns in Focal Therapy for Prostate Cancer

Koehler,

Lazarovich,

Tayebi

et al. 2024

Preprint

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Purpose: Focal therapy (FT) is emerging as an alternative option to radical treatments for prostate cancer (CaP). The purpose of this study is to assess urologists’ current perceptions and utilization of FT. Methods: A 22-item questionnaire was emailed to members of the American Urological Association. Multivariate logistic regression analysis was used to identify predictors of FT utilization. Results were also compared to a previous survey performed in 2017. Results: A total of 264 responses were recorded. Less than half (115/264, 43.6%) of respondents utilize FT in their practice; among them, 42% perform FT on more than 10 patients/year. Common reasons for avoiding FT were diverse and included: lack of experience (51.8%), belief that CaP is multifocal (46.0%), and a lack of infrastructure (43.1%). The most commonly utilized modality for FT was high-intensity focused ultrasound (63.4%) followed by cryoablation (47.3%). Preferred patients selected for FT were primarily unilateral/anterior only Gleason Grade Group 2 (95/110, 86.4%). A fellowship training in urologic oncology (OR=2.86, p=0.008) and seeing more than 10 CaP patients per month (OR=2.46, p=0.002) were associated with greater utilization of FT. Most respondents (85.4%) cited better imaging methods as a factor that has increased FT utilization. Compared to a previous survey, a higher number of respondents (43% vs. 24%) utilize FT in their practice and more respondents believe in the "index lesion theory". Conclusions: Less than half of the respondents utilize FT in their practice. Fellowship training in urologic oncology and a higher volume of CaP patients were correlated with FT utilization. As urologists gain more experience the trend of further utilization of FT for CaP may rise.

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Section: Discussionmentioning

confidence: 95%

Shifting Tides: A Survey Analysis of Urologists' Evolving Attitudes and Practice Patterns in Focal Therapy for Prostate Cancer

Koehler,

Lazarovich,

Tayebi

et al. 2024

Preprint

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“…Medium-term results of several energies have already proved promising ( 19 ). Nonetheless, on a longer follow-up, up to one in two men need some form of re-treatment due to PCa recurrence and/or persistence ( 20 – 23 ). Thus, recurrent PCa following non-surgical first-line treatment is further likely to grow in the near future.…”

Section: Introductionmentioning

confidence: 99%

The SAFE Pilot Trial—SAlvage Focal Irreversible Electroporation—For Recurrent Localized Prostate Cancer: Rationale and Study Protocol

et al. 2022

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IntroductionCurrently, the majority of prostate cancer (PCa) recurrences after non-surgical first-line treatment are managed with androgen-deprivation therapy (ADT). Salvage radical prostatectomy (sRP) is a curative alternative to ADT but yields significant morbidity. Preliminary evidence from focal salvage treatments shows similar oncological control but lower morbidity compared to sRP. Among available ablative focal energies, irreversible electroporation (IRE) is a treatment modality that proved promising, especially in treating apical lesions, where PCa most often recurs. Our aim is to test the safety of salvage IRE for recurrent PCa.MethodsWe performed a single-arm pilot feasibility study (IDEAL stage 2a): SAFE, SAlvage Focal irreversible Electroporation for recurrent localized PCa. Twenty patients with biopsy-proven PCa recurrence after primary non-surgical (radiation or ablation) treatment were included. All men will undergo mpMRI ± targeted biopsies, pre-operative PSMA-PET staging before inclusion and sIRE. Outcomes will be evaluated through internationally validated questionnaires and morbidity scales. All men will undergo a control biopsy at one year.ResultsPrimary objectives were the evaluation of the safety of sIRE (and patients’ quality of life) after treatment. Secondary objectives were the evaluation of functional outcomes, namely, continence and erectile function changes and evaluation of short-term oncological efficacy.ConclusionsSAFE is the second pilot study to evaluate sIRE and the first one performed according to the most recent diagnostic and staging imaging standards. sIRE may provide a curative option for recurrent PCa together with lower comorbidities compared to sRP.

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“…In the face of variability, patient selection naturally assumes importance. Detractors of focal therapy often lament that despite recent advances, up to 50% men may be incorrectly selected for focal therapy [9 ▪ ]. In this narrative review, we elucidate clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation with a specific emphasis on recent literature dating beyond 2018.…”

Section: Introductionmentioning

confidence: 99%

Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer

Jaipuria

Ahmed

2022

Current Opinion in Urology

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Purpose of reviewFocal therapy or partial gland ablation for nonmetastatic prostate cancer is gaining popularity not just as an alternative to active surveillance, but as an acceptable alternative to whole gland therapy in appropriate cases. This review summarizes recent evidence to help select patients for optimal outcomes.Recent findingsRecommendations by expert panels have become less conservative with each meeting. As experience with older modalities for focal therapy grows, newer modalities continue to be introduced. We are now in a position to offer personalized treatment pathway considering nuances of each focal therapy modality.SummaryThe ideal case for focal therapy should be an MRI visible significant lesion (PIRADS score ≥ 3), with a positive biopsy for significant cancer (Gleason grade group 2–3) in the corresponding targeted biopsy area, and insignificant or absent disease in the nontarget random biopsy areas. Multifocal disease can also be selectively treated. Salvage focal ablation is an attractive treatment option for radio-recurrent or index focal therapy failure cases.

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Making a case “against” focal therapy for intermediate-risk prostate cancer

Cited by 8 publications

References 66 publications

Shifting Tides: A Survey Analysis of Urologists' Evolving Attitudes and Practice Patterns in Focal Therapy for Prostate Cancer

Shifting Tides: A Survey Analysis of Urologists' Evolving Attitudes and Practice Patterns in Focal Therapy for Prostate Cancer

The SAFE Pilot Trial—SAlvage Focal Irreversible Electroporation—For Recurrent Localized Prostate Cancer: Rationale and Study Protocol

Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer

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