title: Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer.
abstract: What's known on the subject? and What does the study add? Active surveillance for prostate cancer is gaining increasing acceptance for low risk prostate cancer. Focal therapy is an emerging tissue preservation strategy that aims for treat only areas of cancer. Early phase trials have shown that side-effects can be significantly reduced using focal therapy. There is significant uncertainty in both active surveillance and focal therapy. This consensus group paper provides a road-map for clinical practice and research for both tissue-preserving strategies in the areas of patient population, tools for risk stratification and cancer localisation, treatment interventions as well as comparators and outcome measures in future comparative trials.
  
  
  OBJECTIVE
  To reach consensus on key issues for clinical practice and future research in active surveillance and focal therapy in managing localized prostate cancer.
  
  
  METHODS
  A group of expert urologists, oncologists, radiologists, pathologists and computer scientists from North America and Europe met to discuss issues in patient population, interventions, comparators and outcome measures to use in both tissue-preserving strategies of active surveillance and focal therapy. Break-out sessions were formed to provide agreement or highlight areas of disagreement on individual topics which were then collated by a writing group into statements that formed the basis of this report and agreed upon by the whole Transatlantic Consensus Group.
  
  
  RESULTS
  The Transatlantic group propose that emerging diagnostic tools such as precision imaging and transperineal prostate mapping biopsy can improve prostate cancer care. These tools should be integrated into prostate cancer management and research so that better risk stratification and more effective treatment allocation can be applied. The group envisaged a process of care in which active surveillance, focal therapy, and radical treatments lie on a continuum of complementary therapies for men with a range of disease grades and burdens, rather than being applied in the mutually exclusive and competitive way they are now.
  
  
  CONCLUSIONS
  The changing landscape of prostate cancer epidemiology requires the medical community to re-evaluate the entire prostate cancer diagnostic and treatment pathway in order to minimize harms resulting from over-diagnosis and over-treatment. Precise risk stratification at every point in this pathway is required alongside paradigm shifts in our thinking about what constitutes cancer in the prostate.
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK.
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
authors.forename: Oguz
authors.initials: O
authors.lastname: Akin
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Coleman
authors.forename: Sarah
authors.initials: S
authors.lastname: Crane
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.forename: Larry
authors.initials: L
authors.lastname: Goldenberg
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
authors.forename: Mike W
authors.initials: MW
authors.lastname: Kattan
authors.forename: John
authors.initials: J
authors.lastname: Kurhanewicz
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Moore
authors.forename: Chris
authors.initials: C
authors.lastname: Parker
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Peter
authors.initials: P
authors.lastname: Scardino
authors.forename: Nicholas
authors.initials: N
authors.lastname: van As
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
mesh_terms: D055011:Ablation Techniques; D001707:Biopsy, Needle; D003952:Diagnostic Imaging; D005060:Europe; D006801:Humans; D008297:Male; D009656:North America; D018579:Patient Selection; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D012307:Risk Factors
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