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


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, ; (2014) Can we deliver randomized trials of focal therapy in prostate cancer? Nature reviews Clinical oncology, 11 (8). pp. 482-91. ISSN 1759-4774 DOI: https://doi.org/10.1038/nrclinonc.2014.44

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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 (≤ cT2cN0M0). 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 24751803
Web of Science ID: 340074900006
URI: http://researchonline.lshtm.ac.uk/id/eprint/1689045

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