Standardized Nomenclature and Surveillance Methodologies After Focal Therapy and Partial Gland Ablation for Localized Prostate Cancer: An International Multidisciplinary Consensus

Abstract

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 ultrasound-guided 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.

Keywords: Focal therapy; Nomenclature; Partial gland ablation; Surveillance.

Copyright © 2020. Published by Elsevier B.V.

Figures

Fig. 1 –

Focal therapy versus partial gland ablative procedures. Graphics demonstrating distinction between focal therapy and templated organ-preserving partial gland ablations. Focal therapy: image-guided focused ablation of image-visible, biopsy-confirmed malignant lesion(s) plus an adequate safety margin. Quadrant ablation: destruction of all prostate tissue within a quadrant of the prostate. Hemiablation: destruction of all prostate tissue within a lateralized hemisphere of the prostate or the anterior half of the prostate. Hockey stick: destruction of all prostate tissue within a lateralized hemisphere plus anterior contralateral region. Subtotal ablation: destruction of most of the prostate tissue with preservation of a posterior lateral region (unilaterally or bilaterally). The goal intended is to preserve at least one neurovascular bundle during ablation.