To provide a contemporary statement on focal therapy (FT) for localised prostate cancer (PCa) from an international and diverse group of physicians treating localised PCa, with the aim of overcoming the limitations of previous consensus statements, which were restricted to early adopters, and to offer direction regarding the various aspects of FT application that are currently not well defined.
The FocAL therapy CONsensus (FALCON) project began with a 154-item online survey, developed following a steering committee discussion and literature search. Invitations to participate were extended to a large, diverse group of professionals experienced in PCa management. From 2022 to 2023, a Delphi consensus study consisting of three online rounds was conducted using the Modified Delphi method. A 1-9 Likert scale was used for the survey, which was followed by an in-person expert meeting. The threshold for achieving consensus was set at 70% agreement/disagreement. Six main aspects of FT were covered: (i) patient selection; (ii) energy source selection; (iii) treatment approach; (iv) treatment evaluation and follow-up; (v) treatment cost and accessibility; and (vi) future perspectives.
Of 246 initial participants, 148 (60%) completed all three rounds. Based on participant feedback, 27 new statements were added in the second round, and 33 questions related to personal expertise, for which consensus was not necessary, were excluded. After the third and final round, consensus had not been reached for 69 items. These items were discussed at the in-person meeting, resulting in a consensus of 57 additional items. Consensus was finally not reached on 12 items. Given the volume of data, the voting outcomes are summarised in this article, with a detailed breakdown presented in the form of figures and tables.
The FALCON project delivered a significant consensus on the approach to FT for localised PCa. Additionally, it highlighted gaps in our knowledge that may provide guidance for future research.
BJU international. 2025 Feb 04 [Epub ahead of print]
Lara Rodriguez-Sanchez, Xavier Cathelineau, Theo M de Reijke, Phillip Stricker, Mark Emberton, Anna Lantz, Bernardino Miñana López, Jose Luis Dominguez-Escrig, Fernando J Bianco, Georg Salomon, Aiman Haider, Anita Mitra, Alberto Bossi, Eva Compérat, Robert Reiter, Pilar Laguna, Gaelle Fiard, Luca Lunelli, George R Schade, Peter Ka-Fung Chiu, Petr Macek, Veeru Kasivisvanathan, Jean J M C H Rosette, Thomas J Polascik, Ardeshir R Rastinehad, Alejandro Rodriguez, Rafael Sanchez-Salas, FALCON group
Department of Urology, Institut Mutualiste Montsouris, Paris, France., Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., Garvan Institute of Medical Research, Sydney, NSW, Australia., Interventional Oncology, Division of Surgery and Interventional Science, University College London, London, UK., Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Department of Urology, Clinica Universidad de Navarra, Madrid, Spain., Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain., Urological Research Network, Miami, FL, USA., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK., Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France., Department of Pathology, Medical University of Vienna, Vienna, Austria., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., International School of Medicine, Istanbul Medipol University, Istanbul, Turkey., Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France., Department of Urology, Hospital Louis Pasteur, Chartres, France., Department of Urology, University of Washington School of Medicine, Seattle, WA, USA., Division of Urology, Department of Surgery, Faculty of Medicine, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China., Division of Surgery and Interventional Science, University College, London, UK., Department of Urological Surgery, Duke University Medical Center, Durham, NC, USA., Department of Urology, Lenox Hill Hospital, New York, NY, USA., Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA., Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.