Utilization of focal therapy for patients discontinuing active surveillance of prostate cancer: Recommendations of an international Delphi consensus.

Journal Article (Journal Article)

BACKGROUND: With the advancement of imaging technology, focal therapy (FT) has been gaining acceptance for the treatment of select patients with localized prostate cancer (CaP). We aim to provide details of a formal physician consensus on the utilization of FT for patients with CaP who are discontinuing active surveillance (AS). METHODS: A 3-stage Delphi consensus on CaP and FT was conducted. Consensus was defined as agreement by ≥80% of physicians. An in-person meeting was attended by 17 panelists to formulate the consensus statement. RESULTS: Fifty-six respondents participated in this interdisciplinary consensus study (82% urologist, 16% radiologist, 2% radiation oncology). The participants confirmed that there is a role for FT in men discontinuing AS (48% strongly agree, 39% agree). The benefit of FT over radical therapy for men coming off AS is: less invasive (91%), has a greater likelihood to preserve erectile function (91%), has a greater likelihood to preserve urinary continence (91%), has fewer side effects (86%), and has early recovery post-treatment (80%). Patients will need to undergo mpMRI of the prostate and/or a saturation biopsy to determine if they are potential candidates for FT. Our limitations include respondent's biases and that the participants of this consensus may not represent the larger medical community. CONCLUSIONS: FT can be offered to men coming off AS between the age of 60 to 80 with grade group 2 localized cancer. This consensus from a multidisciplinary, multi-institutional, international expert panel provides a contemporary insight utilizing FT for CaP in select patients who are discontinuing AS.

Full Text

Duke Authors

Cited Authors

  • Tan, WP; Rastinehad, AR; Klotz, L; Carroll, PR; Emberton, M; Feller, JF; George, AK; Gill, IS; Gupta, RT; Katz, AE; Lebastchi, AH; Marks, LS; Marra, G; Pinto, PA; Song, DY; Sidana, A; Ward, JF; Sanchez-Salas, R; Rosette, JDL; Polascik, TJ; Focal Therapy Group Authors,

Published Date

  • November 2021

Published In

Volume / Issue

  • 39 / 11

Start / End Page

  • 781.e17 - 781.e24

PubMed ID

  • 33676851

Pubmed Central ID

  • PMC8654321

Electronic International Standard Serial Number (EISSN)

  • 1873-2496

Digital Object Identifier (DOI)

  • 10.1016/j.urolonc.2021.01.027


  • eng

Conference Location

  • United States