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Tytuł pozycji:

Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project.

Tytuł :
Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project.
Autorzy :
Tay KJ; Duke Cancer Institute, Duke University, Durham, NC, USA.
Scheltema MJ; Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
Ahmed HU; Division of Surgery and Interventional Science, University College of London, London, UK.
Barret E; L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France.
Coleman JA; Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Dominguez-Escrig J; Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain.
Ghai S; University of Toronto, Toronto, ON, Canada.
Huang J; Department of Pathology, Duke University, Durham, NC, USA.
Jones JS; Cleveland Clinic, Cleveland, OH, USA.
Klotz LH; Sunnybrook Medical Center, Toronto, ON, Canada.
Robertson CN; Duke Cancer Institute, Duke University, Durham, NC, USA.
Sanchez-Salas R; L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France.
Scionti S; Saratosa Prostate Cancer Center, Sarasota, FL, USA.
Sivaraman A; L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France.
de la Rosette J; Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
Polascik TJ; Duke Cancer Institute, Duke University, Durham, NC, USA.
Pokaż więcej
Źródło :
Prostate cancer and prostatic diseases [Prostate Cancer Prostatic Dis] 2017 Sep; Vol. 20 (3), pp. 294-299. Date of Electronic Publication: 2017 Mar 28.
Typ publikacji :
Consensus Development Conference; Journal Article
Język :
English
Imprint Name(s) :
Publication: <2002->: London : Nature Publishing Group
Original Publication: Houndmills, Basingstoke, UK : Stockton Press, c1997-
MeSH Terms :
Patient Selection*
Prostatic Neoplasms/*radiotherapy
Humans ; Male ; Prostatic Neoplasms/diagnostic imaging
Entry Date(s) :
Date Created: 20170329 Date Completed: 20180515 Latest Revision: 20180724
Update Code :
20201218
DOI :
10.1038/pcan.2017.8
PMID :
28349978
Czasopismo naukowe
Background: 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.
Methods: 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.
Results: 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.
Conclusions: This consensus provides a contemporary insight into expert opinion of patient selection for FT of clinically localized prostate cancer.

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