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    Focal laser ablation as clinical treatment of prostate cancer: Report from a Delphi consensus project
    (Springer Verlag, 2019) van Luijtelaar, Annemarijke; Greenwood, Bernadette Marie; Ahmed, Hashim Uddin; Barqawi, Al Baha; Barret, Éric; Bomers, Joyce G.R.; Brausi, Maurizio; Choyke, Peter L.; Cooperberg, Matthew R.; Eggener, Scott E.; Feller, John Francis; Frauscher, Ferdinand; George, Arvin Koruthu; Hindley, Richard Graham; Jenniskens, Sjoerd F.M.; Klotz, Laurence; Kovacs, Gyoergy; Lindner, Uri; Loeb, Stacy; Margolis, Daniel Jason Aaron; Marks, Leonard S.; May, Stuart; McClure, Timothy D.; Montironi, Rodolfo; Nour, Sherif Gamal; Oto, Aytekin; Polascik, Thomas James; Rastinehad, Ardeshir R.; de Reyke, T. M.; Reijnen, Jeroen Sebastiaan; de la Rosette, Jean J. M. C. H.; Sedelaar, John Pieter Michiel; Sperling, Dan S.; Walser, Eric M.; Ward, John F.; Villers, Arnauld A.; Ghai, Sangeet; Fütterer, Jürgen Jacobus
    Purpose: To define the role of focal laser ablation (FLA) as clinical treatment of prostate cancer (PCa) using the Delphi consensus method. Methods: A panel of international experts in the field of focal therapy (FT) in PCa conducted a collaborative consensus project using the Delphi method. Experts were invited to online questionnaires focusing on patient selection and treatment of PCa with FLA during four subsequent rounds. After each round, outcomes were displayed, and questionnaires were modified based on the comments provided by panelists. Results were finalized and discussed during face-to-face meetings. Results: Thirty-seven experts agreed to participate, and consensus was achieved on 39/43 topics. Clinically significant PCa (csPCa) was defined as any volume Grade Group 2 [Gleason score (GS) 3+4]. Focal therapy was specified as treatment of all csPCa and can be considered primary treatment as an alternative to radical treatment in carefully selected patients. In patients with intermediate-risk PCa (GS 3+4) as well as patients with MRI-visible and biopsy-confirmed local recurrence, FLA is optimal for targeted ablation of a specific magnetic resonance imaging (MRI)-visible focus. However, FLA should not be applied to candidates for active surveillance and close follow-up is required. Suitability for FLA is based on tumor volume, location to vital structures, GS, MRI-visibility, and biopsy confirmation. Conclusion: Focal laser ablation is a promising technique for treatment of clinically localized PCa and should ideally be performed within approved clinical trials. So far, only few studies have reported on FLA and further validation with longer follow-up is mandatory before widespread clinical implementation is justified.
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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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    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.