Introduction:

Focal therapy (FT) for prostate cancer is increasingly recognized as an acceptable therapeutic option in well selected men. Nevertheless, treatment failure occurs in a non-negligible number of patients. A focal therapy multidisciplinary tumor board (MTB) geared towards improving patient selection for FT is a novel concept which has not been reported. The impact of conducting re-review of radiographic exams and histopathology during MTB may also help refine FT candidacy and potentially reduce failure rates. To describe a single institution’s initial experience with MTB for patients being referred for FT consideration and its outcomes in terms of patient selection.

Methods:

Single-center, prospective study of patients referred to a MTB consisting of urologists, radiation and medical oncologists, genitourinary radiologists and pathologists. All prostate MRI’s were re-reviewed by a single radiologist with >10 years of experience, and the number, size, location and PI-RADS scores of lesions visible on MRI were recorded and compared to the original report. Outside histopathology, when requested, was also re-reviewed and cancer grade groups and adverse pathologic features (such as cribriform gland and intraductal morphology) were recorded. A descriptive statistical analysis was performed.

Results:

Forty-five patients were presented at the MTB between January 2022-July 2022. Patient demographics are presented in Table 1.  Thirty-nine patients were treatment naïve while six had prior radiation +/- ADT.  MRI overread was performed on all treatment naïve patients (39/45, 87%), and pathology overreads on 11/45 (24.4%) patients. Four patients were excluded upfront due to Urolift device (n=1), J-pouch (n=1), and suspicion of metastasis at time of presentation (n=2). Among patients with MRI overreads, 44.7% (17/39) were found to have findings not included in the original report that negatively impacted immediate eligibility for FT, including lesion crossing anteriorly to the urethra (9/17) (figure 1), identification of an additional lesion of concern (8/17), discordance of lesion location (3/17) and lesion abutting rectal wall (1/17).  Pathology re-review changed management for 3/11 patients with 2/3 being downgraded to GG1 disease and opting for active surveillance. Twelve patients (26.7%) were deemed candidates for FT.

Conclusion:

MTB increases the selection scrutiny for FT candidates. MRI overreads and review of histopathology can change candidacy based on new or meaningful findings. These initial results suggest that patients being considered for FT should be routinely discussed at MTB and that further research addressing this topic is warranted.

Funding: N/A