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    Making a case "for" focal therapy of the prostate in intermediate risk prostate cancer: Current perspective and ongoing trials
    (Springer, 2021) Wang, Alex Z.; Lebastchi, Amir H.; O'Connor, Luke P.; Ahdoot, Michael; Mehralivand, Sherif; Yerram, Nitin; Taneja, Samir S.; George, Arvin K.; Sanchez-Salas, Rafael; Ward, John F.; del Pilar Laguna Pes, Maria; de la Rosette, Jean J. M. C. H.; Pinto, Peter A.
    Focal therapy is growing as an alternative management options for men with clinically localized prostate cancer. Parallel to the increasing popularity of active surveillance (AS) as a treatment for low-risk disease, there has been an increased interest towards providing focal therapy for patients with intermediate-risk disease. Focal therapy can act as a logical "middle ground" in patients who seek treatment while minimizing potential side effects of definitive whole-gland treatment. The aim of the current review is to define the rationale of focal therapy in patients with intermediate-risk prostate cancer and highlight the importance of patient selection in focal therapy candidacy.
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    Role of multiparametric prostate MRI in the management of prostate cancer
    (Springer, 2021) O'Connor, Luke P.; Lebastchi, Amir H.; Horuz, Rahim; Rastinehad, Ardeshir R.; Siddiqui, M. Minhaj; Grummet, Jeremy; Kastner, Christof; Ahmed, Hashim U.; Pinto, Peter A.; Türkbey, Barış
    Introduction Prostate cancer has traditionally been diagnosed by an elevation in PSA or abnormal exam leading to a systematic transrectal ultrasound (TRUS)-guided biopsy. This diagnostic pathway underdiagnoses clinically significant disease while over diagnosing clinically insignificant disease. In this review, we aim to provide an overview of the recent literature regarding the role of multiparametric MRI (mpMRI) in the management of prostate cancer. Materials and Methods A thorough literature review was performed using PubMed to identify articles discussing use of mpMRI of the prostate in management of prostate cancer. Conclusion The incorporation of mpMRI of the prostate addresses the shortcomings of the prostate biopsy while providing several other advantages. mpMRI allows some men to avoid an immediate biopsy and permits visualization of areas likely to harbor clinically significant cancer prior to biopsy to facilitate use of MR-targeted prostate biopsies. This allows for reduction in diagnosis of clinically insignificant disease as well as improved detection and better characterization of higher risk cancers, as well as the improved selection of patients for active surveillance. In addition, mpMRI can be used for selection and monitoring of patients for active surveillance and treatment planning during surgery and focal therapy.
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    Standardized nomenclature and surveillance methodologies after focal therapy and partial gland ablation for localized prostate cancer: An international multidisciplinary consensus
    (Elsevier, 2020) Lebastchi, Amir H.; George, Arvin Koruthu; Polascik, Thomas J.; Coleman, Jonathan; de la Rosette, Jean J. M. C. H.; Türkbey, Barış; Wood, Bradford J.; Gorin, Michael A.; Sidana, Abhinav; Ghai, Sangeet; Tay, Kae Jack; Ward, John; Sanchez-Salas, Rafael; Muller, Berrend G.; Malavaud, Bernard; Mozer, Pierre; Crouzet, Sebastien; Choyke, Peter L.; Ukimura, Osamu; Rastinehad, Ardeshir R.; Pinto, Peter A.
    Background: Focal therapy (FT) and partial gland ablation (PGA) are quickly adopted by urologists and radiologists as an option for the management of localized prostate cancer.Objective: To find consensus on a standardized nomenclature and to define a follow-up guideline after FT and PGA for localized prostate cancer in clinical practice.Design, setting, and participants: A review of the literature identified controversial topics in the field of FT. Online questionnaires were distributed to experts during three rounds, with the goal to achieve consensus on debated topics. The consensus project was concluded with a face-to-face meeting in which final conclusions were formulated. Outcome measurements and statistical analysis: Controlled feedback of responses of previous rounds were summarized and returned to the participants allowing them to re-evaluate their decisions. The level of agreement to achieve consensus on a topic was set at 80%.Results and limitations: Sixty-five experts participated in this interdisciplinary consensus study (72% urologists; 28% radiologists). The experts propose the use of the herein standardized nomenclature for ablative procedures. After FT/PGA, the following tests should be performed to assess treatment outcomes: prostate-specific antigen (PSA), imaging, biopsies, and functional outcome assessment. Although not a reliable marker for treatment failure, PSA should be measured every 3 mo in the 1st year and every 6 mo thereafter. Magnetic resonance imaging is the preferred image modality and should be performed at 6 and 18 mo after treatment. A systematic 12-core transrectal ultrasoundguided biopsy combined with a targeted biopsy of the treated area should be performed 6-12 mo after treatment. Functional outcomes should be obtained 3-6 mo after treatment for the first time and until stability is attained.Conclusions: The panel recommends the use of the proposed nomenclature and follow-up protocols to generate reliable data supporting a broader implementation of FT as a standard of care for select patients with localized prostate cancer. Patient summary: In this report, we present expert opinion on the use of a standardized nomenclature, and surveillance methodologies after focal therapy and partial gland ablation for localized prostate cancer.
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    Utilization of focal therapy for patients discontinuing active surveillance of prostate cancer: Recommendations of an international delphi consensus
    (Elsevier Science Inc, 2021) Tan, Wei Phin; Rastinehad, Ardeshir R.; Klotz, Laurence; Carroll, Peter R.; Emberton, Mark; Feller, John F.; George, Arvin K.; Gill, Inderbir S.; Gupta, Rajan T.; Katz, Aaron E.; Lebastchi, Amir H.; Marks, Leonard S.; Marra, Giancarlo; Pinto, Peter A.; Song, Daniel Y.; Sidana, Abhinav; Ward, John F.; Sanchez-Salas, Rafael; de la Rosette, Jean J. M. C. H.; Polascik, Thomas J.
    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.