Duke Cancer Institute, Duke University, Durham, NC, USA.
Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
Prostate Cancer Prostatic Dis. 2017 Sep;20(3):294-299. doi: 10.1038/pcan.2017.8. Epub 2017 Mar 28.
Whole-gland extirpation or irradiation is considered the gold standard for curative oncological treatment for localized prostate cancer, but is often associated with sexual and urinary impairment that adversely affects quality of life. This has led to increased interest in developing therapies with effective cancer control but less morbidity. We aimed to provide details of physician consensus on patient selection for prostate focal therapy (FT) in the era of contemporary prostate cancer management.
We undertook a four-stage Delphi consensus project among a panel of 47 international experts in prostate FT. Data on three main domains (role of biopsy/imaging, disease and patient factors) were collected in three iterative rounds of online questionnaires and feedback. Consensus was defined as agreement in ⩾80% of physicians. Finally, an in-person meeting was attended by a core group of 16 experts to review the data and formulate the consensus statement.
Consensus was obtained in 16 of 18 subdomains. Multiparametric magnetic resonance imaging (mpMRI) is a standard imaging tool for patient selection for FT. In the presence of an mpMRI-suspicious lesion, histological confirmation is necessary prior to FT. In addition, systematic biopsy remains necessary to assess mpMRI-negative areas. However, adequate criteria for systematic biopsy remains indeterminate. FT can be recommended in D'Amico low-/intermediate-risk cancer including Gleason 4+3. Gleason 3+4 cancer, where localized, discrete and of favorable size represents the ideal case for FT. Tumor foci <1.5 ml on mpMRI or <20% of the prostate are suitable for FT, or up to 3 ml or 25% if localized to one hemi-gland. Gleason 3+3 at one core 1mm is acceptable in the untreated area. Preservation of sexual function is an important goal, but lack of erectile function should not exclude a patient from FT.
This consensus provides a contemporary insight into expert opinion of patient selection for FT of clinically localized prostate cancer.
全腺体切除术或放疗被认为是局限性前列腺癌有治愈可能的肿瘤治疗金标准，但常伴有性和尿失禁等功能障碍，从而降低了生活质量。这导致人们对开发具有有效癌症控制但发病率较低的治疗方法产生了浓厚的兴趣。我们旨在提供当代前列腺癌管理时代前列腺局灶性治疗（FT）患者选择的医生共识详细信息。
我们在前列腺 FT 领域的 47 名国际专家组成的小组中进行了四轮 Delphi 共识项目。在三轮在线问卷和反馈中收集了三个主要领域（活检/影像学、疾病和患者因素）的数据。共识定义为至少 80%的医生意见一致。最后，由 16 名核心专家参加的现场会议审查了数据并制定了共识声明。
在 18 个子领域中有 16 个子领域达成了共识。多参数磁共振成像（mpMRI）是 FT 患者选择的标准影像学工具。在存在 mpMRI 可疑病变的情况下，在进行 FT 之前需要进行组织学确认。此外，还需要进行系统活检以评估 mpMRI 阴性区域。然而，系统活检的充分标准仍不确定。FT 可推荐用于 D'Amico 低/中危癌症，包括 Gleason 4+3。Gleason 3+4 癌症，如果局限于一个部位且为离散的且大小有利，则为 FT 的理想病例。mpMRI 上肿瘤灶<1.5ml 或前列腺的<20%适合 FT，如果局限于一个半腺体，则<3ml 或 25%。在未治疗区域，一个核心 1mm 处的 Gleason 3+3 是可以接受的。保留性功能是一个重要目标，但勃起功能障碍不应使患者无法接受 FT。
本共识提供了对临床局限性前列腺癌 FT 患者选择的专家意见的现代见解。
