The FORECAST study — Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer

• Published in: Contemporary clinical trials Vol. 44; pp. 175 - 186
• Main Authors: Kanthabalan, A, Shah, T, Arya, M, Punwani, S, Bomanji, J, Haroon, A, Illing, R.O, Latifoltojar, A, Freeman, A, Jameson, C, van der Meulen, J, Charman, S, Emberton, M, Ahmed, H.U
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2015
• Subjects: Cardiovascular; Focal salvage therapy; Hematology, Oncology and Palliative Medicine; Radio-recurrent prostate cancer; Radio-recurrent prostate cancer; Focal salvage therapy
• ISSN: 1551-7144; 1559-2030
• DOI: 10.1016/j.cct.2015.07.004

Abstract Background One-third of men may experience biochemical failure by 8 years 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. 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. 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. 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. 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.