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Surveillance after prostate focal therapy

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Abstract

Introduction

Long-term outcomes from large cohorts are not yet available upon which to base recommended follow-up protocols after prostate focal therapy. This is an updated summary of a 2015 SIU-ICUD review of the best available current evidence and expert consensus on guidelines for surveillance after prostate focal therapy.

Methods

We performed a systematic search of the PubMed, Cochrane and Embase databases to identify studies where primary prostate focal therapy was performed to treat prostate cancer.

Results

Multiparametric magnetic resonance imaging (mpMRI) should be performed at 3–6 months, 12–24 months and at 5 years after focal therapy. Targeted biopsy of the treated zone should be performed at 3–6 months and fusion biopsy of any suspicious lesion seen on mpMRI. Additionally, a systematic biopsy should be performed at 12–24 months and again at 5 years. In histological diagnosis, characteristic changes of each treatment modality should be noted and in indeterminate situations various immunohistochemical molecular markers can be helpful. Small volume 3 + 3 (Prognostic grade group [PGG] 1) or very small volume (< 0.2 cc or < 7 mm diameter) 3 + 4 (PGG 2) are acceptable in the treated zone at longitudinal follow-up. Significant volumes of 3 + 4 (PGG 2) or more within the treated zone should be treated. Any clinically significant cancer subsequently arising within the non-treated zone should be treated and handled in the same way as any de novo prostate cancer. Patients should be counseled regarding whole-gland and focal approaches to treating these new foci where appropriate. One or two well-delineated foci of significant cancer can be ablated to keep the patient in the ‘active surveillance pool’. More extensive disease should be treated with traditional whole-gland techniques.

Conclusion

Focal therapy remains a nascent field largely comprising single center cohorts with little long-term data. Our current post-focal therapy surveillance consensus recommendations represent the synthesis of the best available evidence as well as expert opinion. Further work is necessary to define the most oncologically safe and cost-effective way of following patients after focal therapy.

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Notes

  1. By today’s standards, mpMRI is the best imaging technique, but radiological assessment may entail other imaging modalities to supplant or complement mpMRI in the future.

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Authors and Affiliations

  1. Division of Urology, Duke University, Durham, NC, USA

    Kae Jack Tay & Thomas J. Polascik

  2. Department of Urology, Singapore General Hospital, SingHealth Duke-NUS Academic Medical Center, Singapore, Singapore

    Kae Jack Tay

  3. Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mahul B. Amin

  4. Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Sangeet Ghai

  5. Department of Pathology, Mayo Clinic, Rochester, MN, USA

    Rafael E. Jimenez

  6. Department of Pathology, Royal Prince Alfred Hospital, Sydney, Australia

    James G. Kench

  7. Sunnybrook Research Institute, Toronto, ON, Canada

    Laurence Klotz

  8. School of Medicine, United Hospitals, Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region (Ancona), Ancona, Italy

    Rodolfo Montironi

  9. Department of Urology, Teikyo University, Tokyo, Japan

    Satoru Muto

  10. Departments of Radiology and Urology, Icahn School of Medicine at Mount Sinai, New York, USA

    Ardeshir R. Rastinehad

  11. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Baris Turkbey

  12. Department of Urology, University of Lille, Lille, France

    Arnauld Villers

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  1. Kae Jack Tay
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Contributions

KJT: project development, consensus development, manuscript writing. MBA: project development, consensus development, manuscript writing. SG: consensus development, manuscript writing. REJ: consensus development, manuscript writing. JGK: consensus development, manuscript writing. LHK: consensus development, manuscript writing. RM: consensus development, manuscript writing. SM: consensus development, manuscript writing. ARR: consensus development, manuscript writing. BT: consensus development, manuscript writing. AV: consensus development, manuscript writing. TJP: Project development, consensus development, manuscript writing.

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Correspondence to Kae Jack Tay.

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Tay, K.J., Amin, M.B., Ghai, S. et al. Surveillance after prostate focal therapy. World J Urol 37, 397–407 (2019). https://doi.org/10.1007/s00345-018-2363-y

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