The Feasibility and Value of a Focal Therapy Multidisciplinary Tumor Board, Including Radiographic and Pathologic Overreads in Refining the Selection for High Intensity Focused Ultrasound in Prostate Cancer Patients.

Abstract

Focal therapy (FT) for prostate cancer is increasingly recognized as an acceptable therapeutic option in well selected men. A focal therapy multidisciplinary tumor board (MTB) geared towards improving patient selection is a novel concept, which has not been reported. We describe our institution's initial experience with MTB for FT and its outcomes in terms of patient selection. This was a single-center, prospective study of patients referred to a MTB. 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 for cancer grade groups and adverse pathologic features. A descriptive statistical analysis was performed. Seventy-four were presented at our MTB (January-October 2022). Sixty-seven patients were treatment naïve while 7 had prior radiation +/- ADT. MRI over-read was performed on all treatment naïve patients 67/74 (91%) while pathology over-reads on 14/74 (19.9%). Following MTB, 19 patients (25.6%) were deemed suitable candidates for FT. A total of 24 patients (35.8%) were not deemed HIFU FT candidates based exclusively on findings identified at MRI overread. Pathology re-review changed management for 3/14 patients with 2/3 being downgraded to GG1 disease and opting for active surveillance. MTB for FT is feasible. MRI overread is an essential component of this process and demonstrates significant findings that alters eligibility or management in over a third of patients.