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Minerva Urology and Nephrology 2022 October;74(5):581-9

DOI: 10.23736/S2724-6051.20.04160-0


language: English

Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society

Giancarlo MARRA 1, 2, Maria P. LAGUNA 3, Jochen WALZ 4, Christian P. PAVLOVICH 5, Fernando BIANCO 6, Justin GREGG 7, Amir H. LEBASTCHI 8, Herbert LEPOR 9, Petr MACEK 1, Soroush RAIS-BAHRAMI 10, Cary ROBERTSON 11, Daniel RUKSTALIS 12, Georg SALOMON 13, Osamu UKIMURA 14, Andre L. ABREU 15, Yann BARBE 1, Xavier CATHELINEAU 1, Giorgio GANDAGLIA 16, Arvin K. GEORGE 17, Juan GOMEZ RIVAS 18, Rajan T. GUPTA 19, Nathan LAWRENTSCHUK 20, Veeru KASIVISVANATHAN 21, Derek LOMAS 22, Bernard MALAVAUD 23, Daniel MARGOLIS 24, Yoh MATSUOKA 25, Sherif MEHRALIVAND 26, Marco MOSCHINI 16, 27, Marco ODERDA 2, Hazem ORABI 11, 28, Ardeshir R. RASTINEHAD 29, Mesut REMZI 30, Ariel SCHULMAN 31, Toshitaka SHIN 32, Takumi SHIRAISHI 14, Abhinav SIDANA 33, Sunao SHOJI 34, Armando STABILE 16, Massimo VALERIO 35, Varaha S. TAMMISETTI 7, Wei PHIN TAN 11, Willemien VAN DEN BOS 36, Arnaud VILLERS 37, Peter-Paul WILLEMSE 38, Jean DE LA ROSETTE 3, Thomas POLASCIK 11, Rafael SANCHEZ-SALAS 1 , on behalf of the Focal Therapy Society

1 Department of Urology, Institut Mutualiste Montsouris, Paris, France; 2D epartment of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy; 3 Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey; 4 Department of Urology, Paoli-Calmettes Institute, Marseille, France; 5 Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6 Urological Research Network, Nova University, Miami, FL, USA; 7 Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; 8 Department of Urology, University of Michigan, Ann Arbor, MI, USA; 9 Department of Urology, NYU Langone Medical Center, New York, NY, USA; 10 Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA; 11 Department of Urology, Duke University, Durham, NC, USA; 12 Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA; 13 Martini Clinic, Prostate Cancer Center, Hamburg, Germany; 14 Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan; 15 Department of Urology, Keck School of Medicine, University of South California, Los Angeles, CA, USA; 16 Department of Urology, San Raffaele Hospital, Milan, Italy; 17 Division of Urologic Oncology, Department of Urology, Michigan Medicine, Ann Arbor, MI, USA; 18 Department of Urology, La Paz University Hospital, Madrid, Spain; 19 Department of Radiology, Duke University, Durham, NC, USA; 20 Department of Urology, Peter MacCallum Cancer Center, Melbourne, Australia; 21 Department of Urology, University College London Hospitals, London, UK; 22 Department of Urology, San Raffaele Hospital, Milan, Italy; 23 Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France; 24 Department of Radiology, Weill Cornell Imaging, Cornell University, New York, NY, USA; 25 Urology at Tokyo Medical and Dental University, Tokyo, Japan; 26 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; 27 Department of Urology, Lucerne Kanton Hospital, Lucerne, Switzerland; 28 Department of Urology, University of Assiut, Assiut, Egypt; 29 Department of Urology, Lenox Hill Urology, New York, NY, USA; 30 Department of Urology, Döbling Hospital, Vienna, Austria; 31Department of Urology, Maimonides Medical Center, Brooklyn, NY, USA; 32 Department of Urology, Oita University, Oita, Japan; 33 Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 34 Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan; 35 Department of Urology, Vaudois University Center Hospital, Lausanne, Switzerland; 36 Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 37 Department of Urology, CHU de Lille, Lille, France; 38 Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands

BACKGROUND: Focal therapy (FT) for prostate cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localized PCa.
METHODS: A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, 1) the current/present role; 2) the potential/future role; 3) the recommended features for future studies. Consensus was defined using a 70% agreement threshold.
RESULTS: Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (N.=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (N.=3), a consensus on a partial agreement (N.=1), and a consensus on uncertainty (N.=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localized PCa. Research efforts in this field should be considered a priority.
CONCLUSIONS: The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.

KEY WORDS: Prostatic neoplasms cancer; Biomarkers, tumor; Delphi technique

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