We all grew up with the concept of majority rule. It’s the idea that when more than half the people decide on something, everyone is compelled to abide by it. Or, whichever group has the most supporters determines everyone’s fate, including their own. It generally works for organizing government and deciding issues.

However, majority rule would not work very well for making decisions about focal treatment for patients with localized PCa. There are many considerations such as which patients with localized PCa would do well with focal therapy, which method to use, the extent of the treatment, how to monitor treatment success, etc.

In addition, the 20-year evolution of focal therapy is something of a patchwork quilt. It has involved many contributors around the world: pioneering theorists, engineers, device manufacturers, and the determined physicians and patients willing to explore alternatives to whole gland surgery and radiation. Focal treatment sprouted up in assorted locations. Practitioners had to seek each other out to learn from each other, since initially there were few presentations at international conferences, and often such sessions were sparsely attended. Gradually, there were enough patients to begin to gather data, but there were no apples-to-apples studies because different centers designed their own research.

Consensus projects

The challenge was, how to create standardized guidelines. Although majority rule is often the most efficient way to impose standards, there are so many variations among PCa patients, and in the nature of the disease itself, that shared information and dialogue about priorities would be required to achieve consensus. A consensus process is definitely not as efficient as taking a vote, but when done well, it is “… inclusive and engages all participants. Consensus decisions can lead to better quality outcomes that empower the group or community to move forward to create their future together.”^[i]

Since 2014 there have been at least 10 focal therapy consensus processes. Most had fewer than 50 participants, the majority of whom have been urologists or other experts such as Dr. Sperling. However, there is vast pool of practitioners whose areas of expertise were not included. To correct this, Dr. Lara Rodríguez Sánchez addressed the 2023 Society of Urologic Oncology (SUO) annual meeting (Nov. 28-Dec. 1, Washington, D.C) to describe the Falcon Project which aims to reach a consensus on focal therapy usage in prostate cancer patients. According to a news report, “With Falcon, there is an attempt to carry out a broad international consensus on focal therapy, including all those who can be part of one of their tumor committees – not necessarily just experts who perform the technique and may provide a biased view strongly in favor of this approach.”

The Falcon Project was held in four rounds, starting in Dec. 2022 with 245 participants. The final discussion occurred Oct. 12, 2023. Over 40 consensus statements were achieved, covering topics in the following areas:

• Patient selection
• Treatment method/approach
• Follow-up/monitoring success

This is the most comprehensive set of guidelines for focal therapy, to date. It also helped identify gaps in knowledge and practice, which will help design future research. The fact that the Falcon Project had robust participation is testimony to the ever-increasing recognition of focal treatment as a standard of care for qualified PCa patients.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] “Benefits to consensus decision making.” University of Minnesota Extension. https://extension.umn.edu/leadership-development/benefits-consensus-decision-making