title: Focal therapy: patients, interventions, and outcomes--a report from a consensus meeting.
abstract: BACKGROUND
  Focal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field.
  
  
  OBJECTIVE
  To gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design.
  
  
  METHODS
  Fifteen experts in focal therapy followed a modified two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology process. All participants independently scored 246 statements prior to rescoring at a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of Medicine, London, supported by the Wellcome Trust and the UK Department of Health.
  
  
  METHODS
  Agreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level.
  
  
  CONCLUSIONS
  Of 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging-targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3+3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus.
  
  
  CONCLUSIONS
  The landscape of PCa treatment is rapidly evolving with new treatment technologies. This consensus meeting provides guidance to clinicians on current expert thinking in the field of focal therapy.
  
  
  RESULTS
  In this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer.
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK. Electronic address: i.donaldson@ucl.ac.uk.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Donaldson
authors.affiliation: Department of Clinical Oncology, Royal Marsden Hospital, London, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Alonzi
authors.affiliation: Centre for Medical Image Computing, University College London, London, UK.
authors.forename: Dean
authors.initials: D
authors.lastname: Barratt
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.affiliation: Department of Urology, Oslo University Hospital, Oslo, Norway.
authors.forename: Viktor
authors.initials: V
authors.lastname: Berge
authors.affiliation: Department of Urology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bott
authors.affiliation: Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: David
authors.initials: D
authors.lastname: Bottomley
authors.affiliation: Section of Urology, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Eggener
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.affiliation: Department of Urology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hindley
authors.affiliation: Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Leslie
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Alec
authors.initials: A
authors.lastname: Miners
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: McCartan
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Moore
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Pinto
authors.affiliation: Division of Urology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Simmons
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
authors.affiliation: Department of Urology, Hôpital Huriez, CHRU Lille, Lille, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Willis
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D001706:Biopsy; D032921:Consensus; D006801:Humans; D008131:London; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: Consensus development conference; Organ-sparing treatments; Prostatic neoplasms