The FORECAST Study - Focal Recurrent Assessment and Salvage Treatment for Radiorecurrent Prostate Cancer.


Kanthabalan, A; Shah, T; Arya, M; Punwani, S; Bomanji, J; Haroon, A; Illing, RO; Latifoltojar, A; Freeman, A; Jameson, C; van der Meulen, J; Charman, S; Emberton, M; Ahmed, HU; (2015) The FORECAST Study - Focal Recurrent Assessment and Salvage Treatment for Radiorecurrent Prostate Cancer. Contemporary clinical trials. ISSN 1551-7144 DOI: https://doi.org/10.1016/j.cct.2015.07.004

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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.<br/> AIM: 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.<br/> 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.<br/> 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.<br/> CONCLUSION: 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 26184343
Web of Science ID: 362616300024
URI: http://researchonline.lshtm.ac.uk/id/eprint/2242019

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