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    Molecular biomarkers in the context of focal therapy for prostate cancer: Recommendations of a delphi consensus from the focal therapy society
    (Edizioni Minerva Medica, 2022) Marra, Giancarlo; del Pilar Laguna Pes, Maria; Walz, Jochen; Pavlovich, Christian P.; Bianco, Fernando; Gregg, Justin; Lebastchi, Amir H.; Lepor, Herbert; Macek, Petr; Rais-Bahrami, Soroush; Robertson, Cary; Rukstalis, Daniel; Salomon, Georg; Ukimura, Osamu; Abreu, Andre L.; Barbe, Yann; Cathelineau, Xavier; Gandaglia, Giorgio; George, Arvin K.; Gomez Rivas, Juan; Gupta, Rajan T.; Lawrentschuk, Nathan; Kasivisvanathan, Veeru; Lomas, Derek; Malavaud, Bernard; Margolis, Daniel; Matsuoka, Yoh; Mehralivand, Sherif; Moschini, Marco; Oderda, Marco; Orabi, Hazem; Rastinehad, Ardeshir R.; Remzi, Mesut; Schulman, Ariel; Shin, Toshitaka; Shiraishi, Takumi; Sidana, Abhinav; Shoji, Sunao; Stabile, Armando; Valerio, Massimo; Tammisetti, Varaha S.; Phin Tan, Wei; van Den Bos, Willemien; Villers, Arnaud; Willemse, Peter-Paul; de la Rosette, Jean J. M. C. H.; Polascik, Thomas; Sanchez-Salas, Rafael
    BACKGROUND: Focal therapy (FT) for prostate cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localized PCa. METHODS: A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, 1) the current/present role; 2) the potential/future role; 3) the recommended features for future studies. Consensus was defined using a 70% agreement threshold. RESULTS: Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (N.=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (N.=3), a consensus on a partial agreement (N.=1), and a consensus on uncertainty (N.=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localized PCa. Research efforts in this field should be considered a priority. CONCLUSIONS: The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.
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    Refining partial gland ablation for localised prostate cancer: the FALCON project
    (2025) Rodriguez Sanchez, Lara; Cathelineau, Xavier; De Reijke, Theo; Stricker, Phillip; Emberton, Mark; del Pilar Laguna Pes, Maria; Sanchez Salas, Rafael
    Objectives: To provide a contemporary statement on focal therapy (FT) for localised prostate cancer (PCa) from an international and diverse group of physicians treating localised PCa, with the aim of overcoming the limitations of previous consensus statements, which were restricted to early adopters, and to offer direction regarding the various aspects of FT application that are currently not well defined. Materials and Methods: The FocAL therapy CONsensus (FALCON) project began with a 154-item online survey, developed following a steering committee discussion and literature search. Invitations to participate were extended to a large, diverse group of professionals experienced in PCa management. From 2022 to 2023, a Delphi consensus study consisting of three online rounds was conducted using the Modified Delphi method. A 1–9 Likert scale was used for the survey, which was followed by an in-person expert meeting. The threshold for achieving consensus was set at 70% agreement/disagreement. Six main aspects of FT were covered: (i) patient selection; (ii) energy source selection; (iii) treatment approach; (iv) treatment evaluation and follow-up; (v) treatment cost and accessibility; and (vi) future perspectives. Results: Of 246 initial participants, 148 (60%) completed all three rounds. Based on participant feedback, 27 new statements were added in the second round, and 33 questions related to personal expertise, for which consensus was not necessary, were excluded. After the third and final round, consensus had not been reached for 69 items. These items were discussed at the in-person meeting, resulting in a consensus of 57 additional items. Consensus was finally not reached on 12 items. Given the volume of data, the voting outcomes are summarised in this article, with a detailed breakdown presented in the form of figures and tables. Conclusions: The FALCON project delivered a significant consensus on the approach to FT for localised PCa. Additionally, it highlighted gaps in our knowledge that may provide guidance for future research.