Thomas J. Polascik, MD, FACS, presented “Utilization of Focal Therapy for Patients Discontinuing Active Surveillance of Prostate Cancer: Recommendations of an International Delphi Consensus” during the 25th Annual Southwest Prostate Cancer Symposium conference on December 11, 2021, in Scottsdale, Arizona.
How to cite: Polascik, Thomas J. “Utilization of Focal Therapy for Patients Discontinuing Active Surveillance of Prostate Cancer: Recommendations of an International Delphi Consensus.” December 11, 2021. Accessed Nov 2024. https://grandroundsinurology.com/utilization-of-focal-therapy-for-patients-discontinuing-active-surveillance-of-prostate-cancer-recommendations-of-an-international-delphi-consensus/
Utilization of Focal Therapy for Patients Discontinuing Active Surveillance of Prostate Cancer: Recommendations of an International Delphi Consensus – Summary
Thomas J. Polascik, MD, FACS, Professor of Surgery at Duke University and Director of Surgical Technology at the Duke Prostate and Urological Cancer Center, posits that patients discontinuing active surveillance (AS) for prostate cancer may be good candidates for focal therapy (FT) rather than radical therapy, describing an international Delphi Consensus on the issue. He provides background, explaining that no study to date has evaluated FT for men discontinuing AS. Dr. Polascik describes the Delphi Consensus components and process. It used online surveys and face-to-face meetings to determine an expert consensus on the utilization of FT for these patients, with 80 percent agreement constituting consensus. Dr. Polascik shared some of the participant demographics, asserting the cohort was not made up of doctors who were already primarily performing FT. One survey question asked “Do you agree there is a role for FT for men coming off AS?” Eighty-seven percent of respondents answered that they agree or strongly agree. That FT is less invasive, has a greater likelihood of preserving both urinary continence and erectile function, comes with fewer side effects, and has an earlier recovery post-treatment are all reasons cited in the survey as part of the rationale for recommending FT over radical therapy for men discontinuing AS (assuming an imageable, biopsy-confirmed, localized cancer). Further, the group came to consensus that no metastatic workup is usually required prior to consideration of FT. Dr. Polascik covers additional topics addressed in the survey, including factors related to patient age, PSA-related criteria, biomarkers, biopsy techniques, various scenarios under which FT may or may not be considered, and ablation templates/schemes. In terms of questions concerning the ideal template for FT, whereby the panel did not come to consensus, responses did illustrate the fact that FT is highly customizable for various situations. In conclusion, the Delphi Consensus defined the ideal candidates as men 60-80 with GG2 localized disease with PSA<10 ng/mL and explained that multiparametric magnetic resonance imaging/ultrasound (mpMRI/US)-guided fusion biopsy and a 12-core systematic biopsy is recommended for men considering FT.
About the 25th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, and Richard G. Stock, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
ABOUT THE AUTHOR
Thomas J. Polascik, MD, FACS, is Professor of Surgery at Duke University Medical Center and the Director of Surgical Technology at the Duke Prostate and Urological Cancer Center. He is the Founder and Co-Director of the International Symposium on Focal Therapy and Imaging of Prostate and Kidney Cancer, which began at Duke in 2008. Dr. Polascik is the Editor of Imaging and Focal Therapy of Early Prostate Cancer. He is Founder and President of the Focal Therapy Society, as well as Director of Duke’s Society of Urologic Oncology Fellowship Training Program and the Genitourinary Program on Focal Therapy at the Duke Cancer Institute. He is the Medical Director of Duke’s Men’s Health Initiative Screening Event and is a governing member of several medical boards and societies. His clinical and research interests focus on prostate and kidney cancer. He has authored over 350 peer-reviewed manuscripts and book chapters.
