title: The FORECAST study - Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer.
abstract: BACKGROUND
  One-third of men may experience biochemical failure by 8years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and characterised.
  
  
  OBJECTIVE
  FORECAST - Focal Recurrent Assessment and Salvage Treatment - is a study designed to evaluate a novel imaging-based diagnostic and therapeutic complex intervention pathway for men who fail radiotherapy.
  
  
  METHODS
  Men with biochemical failure following radical prostate radiotherapy, prior to salvage therapy will be recruited. They will undergo whole-body multi-parametric MRI (WB-MRI), choline PET/CT, bone-scan and pelvic-mpMRI and then MRI transperineal-targeted biopsies (MRI-TB) and Transperineal Template Prostate Mapping Biopsy (TPM). Those suitable for FST will undergo either high intensity focused ultrasound (HIFU) or cryotherapy.
  
  
  RESULTS
  Primary outcome measures: a) the accuracy of WB-MRI to detect distant metastatic disease; b) accuracy of prostate mpMRI in local detection of radiorecurrent prostate cancer; c) detection accuracy of MRI-TB; and d) rate of urinary incontinence following FST.
  
  
  CONCLUSIONS
  Focal salvage therapy may confer lower rates of morbidity whilst retaining disease control. In order to deliver FST, intra- and extra-prostatic disease must be detected early and localised accurately. Novel diagnostic techniques including WB-MRI and MRI-TB may improve the detection of distant and local disease whilst reducing healthcare burdens compared with current imaging and biopsy strategies.
authors.affiliation: Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK. Electronic address: ana-k@doctors.org.uk.
authors.forename: A
authors.initials: A
authors.lastname: Kanthabalan
authors.affiliation: Division of Surgery and Interventional Science, University College London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Shah
authors.affiliation: Department of Urology, UCLH NHS Foundation Trust, UK.
authors.forename: M
authors.initials: M
authors.lastname: Arya
authors.affiliation: Department of Radiology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Punwani
authors.affiliation: Institute of Nuclear Medicine, UCLH NHS Foundation Trust, UK.
authors.forename: J
authors.initials: J
authors.lastname: Bomanji
authors.affiliation: Centre for Medical Imaging and Computing, University College London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Haroon
authors.affiliation: Department of Radiology, UCLH NHS Foundation Trust, UK.
authors.forename: R O
authors.initials: RO
authors.lastname: Illing
authors.affiliation: Department of Urology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Latifoltojar
authors.affiliation: Department of Pathology, UCLH NHS Foundation Trust, UK.
authors.forename: A
authors.initials: A
authors.lastname: Freeman
authors.affiliation: Department of Pathology, UCLH NHS Foundation Trust, UK.
authors.forename: C
authors.initials: C
authors.lastname: Jameson
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: van der Meulen
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Charman
authors.affiliation: Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK.
authors.forename: M
authors.initials: M
authors.lastname: Emberton
authors.affiliation: Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK.
authors.forename: H U
authors.initials: HU
authors.lastname: Ahmed
keywords: Focal salvage therapy; Radio-recurrent prostate cancer