Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project.

PURPOSE - To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa).

METHODS - A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa.

Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated.

RESULTS - Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text.

CONCLUSIONS - Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.

World journal of urology. 2016 Feb 18 [Epub ahead of print]

A W Postema, T M De Reijke, O Ukimura, W Van den Bos, A R Azzouzi, E Barret, D Baumunk, A Blana, A Bossi, M Brausi, J A Coleman, S Crouzet, J Dominguez-Escrig, S Eggener, R Ganzer, S Ghai, I S Gill, R T Gupta, T O Henkel, M Hohenfellner, J S Jones, F Kahmann, C Kastner, K U Köhrmann, G Kovacs, R Miano, R J van Moorselaar, N Mottet, L Osorio, B R Pieters, T J Polascik, A R Rastinehad, G Salomon, R Sanchez-Salas, M Schostak, L Sentker, K J Tay, I M Varkarakis, A Villers, J Walz, J J De la Rosette

Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands. Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands. , USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. , Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands. , Department of Urology, Angers University Hospital, Angers, France. , Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France. , Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany. , Department of Urology, Fuerth Hospital, Fuerth, Germany. , Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France. , Department of Urology, Ospedale Civile Ramazzini, Carpi, Italy. , Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France. , Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain. , Department of Urology, University of Chicago, Chicago, IL, USA. , Department of Urology, University of Leipzig, Leipzig, Germany. , Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada. , USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. , Departments of Radiology, Duke University Medical Center, Durham, NC, USA. , Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany. , Department of Urology, University of Heidelberg, Heidelberg, Germany. , Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. , Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany. , CamPARI Prostate Cancer Clinic, Cancer Directorate, Cambridge University Hospitals Trust, Cambridge, UK. , Department of Urology, Theresien Krankenhaus Mannheim, Mannheim, Germany. , Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany. , Division of Urology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy. , Department of Urology, Free University Medical Centre, Amsterdam, The Netherlands. , Department of Urology, University Hospital St Etienne, Saint-Étienne, France. , Department of Urology, Porto Hospital Centre, Porto, Portugal. , Departments of Radiation Oncology, AMC University Hospital, Amsterdam, The Netherlands. , Departments of Surgery, Duke University Medical Center, Durham, NC, USA. , Department of Urology, Hofstra North Shore-Lij, Hofstra University, Hempstead, NY, USA. , Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. , Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France. , Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany. , Urologische Gemeinschaftspraxis, Sinsheim, Germany. , Departments of Surgery, Duke University Medical Center, Durham, NC, USA. , 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece. , Department of Urology, Lille University Medical Center, Lille, France. , Department of Urology, Institut Paoli-Calmettes, Marseille, France. , Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands.

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