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Can we deliver randomized trials of focal therapy in prostate cancer?

Lookup NU author(s): Professor Rakesh Heer

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Abstract

Tissue-preserving focal therapies, such as brachytherapy, cryotherapy, high-intensity focused ultrasound and photodynamic therapy, aim to target individual cancer lesions rather than the whole prostate. These treatments have emerged as potential interventions for localized prostate cancer to reduce treatment-related adverse-effects associated with whole-gland treatments, such as radical prostatectomy and radiotherapy. In this article, the Prostate Cancer RCT Consensus Group propose that a novel cohort-embedded randomized controlled trial (RCT) would provide a means to study men with clinically significant localized disease, which we defined on the basis of PSA level (<= 15 ng/ml or <= 20 ng/ml), Gleason grade (Gleason pattern <= 4+4 or <= 4+3) and stage (<= cT2cNOMO). This RCT should recruit men who stand to benefit from treatment, with the control arm being whole-gland surgery or radiotherapy. Composite outcomes measuring rates of local and systemic salvage therapies at 3-5 years might best constitute the basis of the primary outcome on which to change practice.

Publication metadata

Author(s): Ahmed HU, Berge V, Bottomley D, Cross W, Heer R, Kaplan R, Leslie T, Parker C, Relton C, Stephens R, Sydes MR, Turnbull L, van der Meulen J, Vickers A, Wilt T, Emberton M, Prostate Cancer RCT Consensus Group

Publication type: Article

Publication status: Published

Journal: Nature Reviews Clinical Oncology

Year: 2014

Volume: 11

Issue: 8

Pages: 482-491

Print publication date: 01/08/2014

Online publication date: 22/04/2014

ISSN (print): 1759-4774

ISSN (electronic): 1759-4782

Publisher: Nature Publishing Group

URL: http://dx.doi.org/10.1038/nrclinonc.2014.44

DOI: 10.1038/nrclinonc.2014.44

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