Focal laser ablation as clinical treatment of prostate cancer: report from a Delphi consensus project
A. van Luijtelaar, B.M. Greenwood, H.U. Ahmed, A.B. Barqawi, E. Barret, J.G.R. Bomers, M.A. Brausi, P.L. Choyke, M.R. Cooperberg, S. Eggener, J.F. Feller, F. Frauscher, A.K. George, R.G. Hindley, S.F.M. Jenniskens, L. Klotz, G. Kovacs, U. Lindner, S. Loeb, D.J. Margolis, L.S. Marks, S. May, T.D. Mcclure, R. Montironi, S.G. Nour, A. Oto, T.J. Polascik, A.R. Rastinehad, T.M. De Reyke, J.S. Reijnen, J.J.M.C.H. de la Rosette, J.P.M. Sedelaar, D.S. Sperling, E.M. Walser, J.F. Ward, A. Villers, S. Ghai and J.J. Fütterer
To define the role of focal laser ablation (FLA) as clinical treatment of prostate cancer (PCa) using the Delphi consensus method. A panel of international experts in the field of focal therapy (FT) in PCa conducted a collaborative consensus project using the Delphi method. Experts were invited to online questionnaires focusing on patient selection and treatment of PCa with FLA during four subsequent rounds. After each round, outcomes were displayed, and questionnaires were modified based on the comments provided by panelists. Results were finalized and discussed during face-to-face meetings. Thirty-seven experts agreed to participate, and consensus was achieved on 39/43 topics. Clinically significant PCa (csPCa) was defined as any volume Grade Group 2 [Gleason score (GS) 3+4]. Focal therapy was specified as treatment of all csPCa and can be considered primary treatment as an alternative to radical treatment in carefully selected patients. In patients with intermediate-risk PCa (GS 3+4) as well as patients with MRI-visible and biopsy-confirmed local recurrence, FLA is optimal for targeted ablation of a specific magnetic resonance imaging (MRI)-visible focus. However, FLA should not be applied to candidates for active surveillance and close follow-up is required. Suitability for FLA is based on tumor volume, location to vital structures, GS, MRI-visibility, and biopsy confirmation. Focal laser ablation is a promising technique for treatment of clinically localized PCa and should ideally be performed within approved clinical trials. So far, only few studies have reported on FLA and further validation with longer follow-up is mandatory before widespread clinical implementation is justified.