Department of Urology, New York Presbyterian-Weill Cornell Medical College, New York, New York.
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
J Urol. 2019 Nov;202(5):952-958. doi: 10.1097/JU.0000000000000357. Epub 2019 Oct 9.
The SPARED CRN (Study of Prostate Ablation Related Energy Devices Coordinated Registry Network) is a private-public partnership between academic and community urologists, the FDA (U.S. Food and Drug Administration), the Medical Device Epidemiology Network and device manufacturers to examine the safety and effectiveness of technologies for partial gland ablation in men with localized prostate cancer.
We report on a recent workshop at the FDA with thought leaders to discuss a critical framework for partial gland ablation, focusing on patient selection, surgical planning, followup, study design and appropriate comparators in terms of adverse events and cancer control outcomes. We summarize salient points from experts in urology, oncology and epidemiology that were presented and discussed in an open forum.
Given the challenges in achieving patient and physician equipoise to perform a randomized trial, as well as an inherent paradigm shift when comparing partial gland ablation (inability to assess prostate specific antigen recurrence) to whole gland treatments, the group focused on objective performance criteria and goals as a platform to guide the creation of single arm studies in the SPARED CRN.
This summit lays the foundation for prospective, multi-center data collection and evaluation of novel medical devices and drug/device combinations for partial gland ablation.
SPARED CRN(前列腺消融相关能源设备研究协调注册网络)是学术和社区泌尿科医生、美国食品和药物管理局(FDA)、医疗器械流行病学网络和设备制造商之间的公私合作伙伴关系,旨在检查局部前列腺癌男性部分腺体消融技术的安全性和有效性。
我们报告了 FDA 最近的一次研讨会,该研讨会的思想领袖讨论了部分腺体消融的关键框架,重点是患者选择、手术计划、随访、研究设计以及不良事件和癌症控制结果方面的适当对照。我们总结了泌尿科、肿瘤学和流行病学专家在公开论坛上提出和讨论的要点。
鉴于在实现患者和医生之间的平衡以进行随机试验以及在比较部分腺体消融(无法评估前列腺特异性抗原复发)与整个腺体治疗时固有范式转变方面存在挑战,该小组专注于客观性能标准和目标作为指导 SPARED CRN 中单臂研究的平台。
此次峰会为前瞻性、多中心收集和评估新型医疗设备和药物/设备组合用于部分腺体消融奠定了基础。