PURPOSE:To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS:A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS:Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION:Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.

Comprehensive multidisciplinary management of prostate cancer (PC) optimizes patients' access to care, rehabilitation and counseling delivered by a team of qualified experts. This is in line with the need for a paradigm shift from a disease-focused to a patient-centered approach underlined also by the European Partnership for Action Against Cancer. The concept of specialised interdisciplinary and multiprofessional PC care to be formalized in Prostate Cancer Units (PCU) was developed by the Prostate Cancer Programme of the European School of Oncology. The first step was the publication in 2011 of the collaborative article "The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper From the European School of Oncology". It was followed by the launch of the PCU Initiative in Europein 2012 in which internationally recognized opinion leaders, among whom representatives of scientific societies, and patient advocates were invited to set standards for quality comprehensive care in PCUs.

Focal therapy can offer the middle ground for treatment between active surveillance and radical therapy in patients with low- and intermediate-risk prostate cancer. Factors that prohibit focal therapy from being standard of care are numerous. Several consensus projects have been conducted to position the utilization of imaging and trial design in focal therapy. However, the literature is still scarce on patient follow-up after focal therapy. For these reasons, an international multidisciplinary consensus project was established in order to reach consensus about a uniform follow-up protocol after focal therapy.

Background: Abiraterone strongly inhibits androgen synthesis but may lead to an increase in mineralocorticoid hormones that may impair its long term tolerability in patients with prostate cancer. At present, the best conceivable treatment for managing the abiraterone-induced mineralocorticoid excess consists of the administration of glucocorticoid replacement at the lowest effective dose and salt deprivation. The drug dose should be modulated by monitoring blood pressure, fluid retention and potassium levels during therapy. Materials and methods: We evaluated prospectively phosphorus, calcium and potassium serum levels in 28 metastatic prostate cancer patients receveing abiraterone in pre and postchemotherapy setting. 10 out of 28 receveid zoledronic acid and calcium supplement as concomitant medication. Biochemical assessment was performed before receveing the first dose of abiraterone and every first day of every cycle. Results: All patients had potassium serum level within normal limits. Hypocalcemia G1 was present in 10% of patients not receveing zoledronic acid . 25% of patients (7/28) showed phosphate serum-low level G3 . In these patients we decided to administer a daily supplement of oral phosphorus with the resolution of the adverse event within 28 days in 6 out of 7 patients. Conclusions: To our knowledge there are no data reporting hypophosphatemia on abiraterone therapy. Patients with metastatic prostate cancer often showed anorexia, fatigue, confusion, anxiety, musculoskeletal pain, tremors. These symptoms could be related to malignancy or advanced age, owing to a combination of several factors. Severe hypophosphatemia cause the same symptomatology. Mild phosphate serum-low level does not require any treatment. However it is important that we identify the presence of moderate or severe hypophosphatemia because a rapid supplementation can result in a better tolerance of abiraterone and a better outcome of these patients.

Background: Prostate cancer is the most frequent malignant tumour in men, and the third highest cause of death from cancer. The widely recognised benefits of a multidisciplinary approach to treating cancer may be particularly important in prostate cancer, where there are so many treatment options to choose from. It offers patients the best chance of receiving high-quality medical procedures administered by a team of specialists in prostate disease, which is able to tailor treatment and observational strategies to their needs, and ensure access to specialist counselling, supportive care and rehabilitation. Material and methods: In april 2013 we began our activity as a Prostate Cancer Unit (PCU). The Unit is organised into a multidisciplinary team which devises and monitors treatment plans specific to each clinical situation. This team of specialists, which includes medical oncologists, urologists, radiotherapists, radiologists, pathologists, nuclear medicine specialists, nurses, psycho-oncologists, data managers, palliative care specialist and physical therapists, addresses the disease at each stage in order to offer personalized diagnosis, treatment, advice and rehabilitation. The PCU meets every other week in Carpi at the Medical Oncology Unit and through videoconference with the Modena Hospital Policlinico. Results: In these two years of activity, we discuss 384 cases of prostate cancer. The discussion have changed the initial proposal in 21 % of cases and have facilitate access to care. We maintened records of the patients who were discussed and from January 2014 we have ECM certification. Conclusions: The establishment of Prostate Cancer Units could provide financial savings and avoid multiple consultations,inappropriate treatments and secondary therapies. Prostate Cancer Units can deliver high-quality care to patients with prostate disease and provide for a multiprofessional management of the disease, due to the continuous interchange among different specialists and care. Our team of specialists is committed to offering the best advice to patients with prostate cancer diagnosis and looking for the most appropriate solutions in each case.

The standard treatment of renal tumours is the resection or enucleation of the tumour through open or laparoscopic surgey. However old pts are at risk and a more conservative approach may be indicated. PRA under local is an effective treatment for small renal tumors in a one day surgery setting. Also AS has been shown to be indicated in these pts. The objectives of this study were to evaluate and compare the oncological outcomes of old pts with renal tumours who received open surgery, PRA or AS and to observe side effects.

You have accessJournal of UrologyProstate Cancer: Advanced1 Apr 2011716 PHASE III STUDY OF INTERMITTENT MAB VS CONTINUOS MAB Fernando M. Calais da Silva, Fernando Calais da Silva, Aldo Bono, Peter Whelan, Maurizio Brausi, Anton Queimadelos, Jose Portillo, and Ziya Kirkali Fernando M. Calais da SilvaFernando M. Calais da Silva Lisbon, Portugal More articles by this author , Fernando Calais da SilvaFernando Calais da Silva Lisbon, Portugal More articles by this author , Aldo BonoAldo Bono Varese, Italy More articles by this author , Peter WhelanPeter Whelan Leeds, United Kingdom More articles by this author , Maurizio BrausiMaurizio Brausi Modena, Italy More articles by this author , Anton QueimadelosAnton Queimadelos Santiago Compostela, Spain More articles by this author , Jose PortilloJose Portillo Santander, Spain More articles by this author , and Ziya KirkaliZiya Kirkali Izmir, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1684AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Few randomised studies have compared intermittent hormonal therapy with continuous therapy for the treatment of advanced prostate cancer. The main publication in 2009 was based upon data with a median follow up of 51 months. We present updated results with extended follow up. The objective is to investigate if intermittent therapy is associated with a shorter survival time. METHODS 766 patients with locally advanced or metastatic prostate cancer received a three month induction treatment. 626 patients whose PSA decreased below 4 ng/ml or to 80% below the initial value, were randomised. Intervention: Patients received cyproterone acetate (CPA) 200 mg for two weeks and then monthly depot injections of a LHRH analogue plus 200 mg of CPA daily during induction. Patients randomised to the intermittent arm ceased treatment while those randomised to the continuous arm received 200 mg of CPA daily sa LHRH analogue RESULTS A total of 474 patients are known to have died, 90 are lost to follow up, of which 37 withdrew mainly for patient refusal and change of therapy. There was no difference in survival, p = 0.61, with hazard ratio 0.96 (95% CI 0.80 to 1.14) and 239 deaths on the intermittent and 235 on the continuous arm. A slight excess of cancer deaths in the intermittent treatment arm (136 versus 109) is balanced by a slight excess of cardiovascular deaths in the continuous arm (68 versus 62), and deaths from other causes (58 versus 41). The hazard ratio of a cancer death is 1.27 (95% CI 0.98, 1.64), p = 0.06 in the intermittent arm compared to the continuous, For cardiovascular deaths the hazard ratios are 1.05 (95% CI 0.75, 1.49), p = 0.77, continuous compared to intermittent, and for other deaths the hazard ratio for continuous compared to intermittent is 1.38 (95% CI 0.93, 2.06), p=0.11. The extended follow up has accumulated a further 135 deaths since the last analysis which used data up to 2005 and exceeds the number of events specified in the original power analysis. The extra 5 years of follow up now means that the study has accumulated almost 3000 person years at risk among the 626 randomised patients and the median follow up is now 57 months compared to 51 months in the publication. CONCLUSIONS Intermittent therapy should be considered for use in routine practice since it is associated with no reduction in survival, no clinically meaningful impairment in quality of life, better sexual activity, and considerable economic benefit to individual and community. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e288 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fernando M. Calais da Silva Lisbon, Portugal More articles by this author Fernando Calais da Silva Lisbon, Portugal More articles by this author Aldo Bono Varese, Italy More articles by this author Peter Whelan Leeds, United Kingdom More articles by this author Maurizio Brausi Modena, Italy More articles by this author Anton Queimadelos Santiago Compostela, Spain More articles by this author Jose Portillo Santander, Spain More articles by this author Ziya Kirkali Izmir, Turkey More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

PRFA ablation of renal tumours under US has been previously reported by several groups to be effective for selected patients with contrast enhancing renal lesions. However, very few centres have reported long-term data (>7years) with this technique. The objective of this report was to evaluate the response rate and lesions modifications in time together with the fate of these high risk patients.

PURPOSE:To establish a consensus in relation to case selection, conduct of therapy, and outcomes that are associated with focal therapy for men with localized prostate cancer. MATERIAL AND METHODS:Urologic surgeons, radiation oncologists, radiologists, and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer. The consensus process was face to face within a structured meeting, in which pertinent clinical issues were raised, discussed, and agreement sought. Where no agreement was possible, this was acknowledged, and the nature of the disagreement noted. RESULTS:Candidates for focal treatment should have unilateral low- to intermediate-risk disease with clinical stage <or=cT(2a). Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used. Currently, the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies. MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results. For general use, however, these new techniques require validation in prospective clinical trials. Until such are performed, MRI will, in most centers, continue to be an investigative tool in assessing eligibility of patients for focal therapy. CONCLUSIONS:Consensus was derived for most of the key aspects of case selection, conduct of treatment, and outcome measures for men who are undergoing focal therapy for localized prostate cancer. The level of agreement achieved will pave the way for future collaborative trials.