Purpose:The summary presented herein represents Part I of the three-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, discussing risk assessment, staging, and risk-based management in patients diagnosed with clinically localized prostate cancer. Please refer to Parts II and III for discussion of principles of active surveillance, surgery and follow-up (Part II), and principles of radiation and future directions (Part III).Materials and Methods:The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. A research librarian conducted searches in Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles.Results:The Clinically Localized Prostate Cancer Panel created evidence- and consensus-based guideline statements to aid clinicians in the management of patients with clinically localized prostate cancer. Statements regarding risk assessment, staging, and risk-based management are detailed herein.Conclusions:This guideline aims to inform clinicians treating patients with clinically localized prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to further improve care for these men.

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Purpose:The summary presented herein represents Part II of the three-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, discussing principles of active surveillance and surgery as well as follow-up for patients after primary treatment. Please refer to Parts I and III for discussion of risk assessment, staging, and risk-based management (Part I), and principles of radiation and future directions (Part III).Materials and Methods:The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. A research librarian conducted searches in Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles.Results:The Clinically Localized Prostate Cancer Panel created evidence- and consensus-based guideline statements to aid clinicians in the management of patients with clinically localized prostate cancer. Statements regarding active surveillance, surgical management, and patient follow-up are detailed.Conclusion:This guideline aims to inform clinicians treating patients with clinically localized prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to further improve care for these men.

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Owing to concerns about overtreatment, urologists are increasingly using active surveillance (AS) as the initial management for men with low-risk prostate cancer. 1,2 Nonetheless, additional progress in this area requires a deeper understanding of the wellestablished and wide variation in use of AS. 3,4 Of particular interest from a quality improvement perspective is whether practice patterns tend to vary widely even among urologists in the same practice and/or based on her or his panel size (ie, the volume of men with low-risk prostate cancer a given urologist manages). In the context of limited resources, the availability of such information may be used to develop efficient improvement interventions aimed at optimizing the implementation of AS among diverse urologists and practice settings. Methods | The Michigan Urological Surgery Improvement Collaborative is a consortium of 43 academic and community urology practices in Michigan that maintains a prospective clinical registry with detailed and validated clinical information for men newly diagnosed as having prostate cancer seen in participating practices. For this analysis, we identified all Michigan Urological Surgery Improvement Collaborative practices with at least 5 urologists who each managed 5 or more men with low-risk prostate cancer from January 2012 through July 2016. We then examined the proportion of men managed primarily with AS across practices and among urologists within each practice, adjusting for differences in patient age and comorbidity. Finally, we fit a linear regression model to estimate the association between the proportion of patients entering AS and urologist panel size. Two-sided testing was performed, with P < .05 considered significant (StataCorp). Each practice obtained institutional review board approval of not-regulated or exempt status or had an expedited review for collaborative participation. As a part of the institutional review board process at all participating sites, it was determined that given the quality improvement focus of the Michigan Urological Surgery Improvement Collaborative and the fact that the data it houses are (1) collected for quality improvement and not human participants research and (2) is collected during routine care of patients (eg, does not require any changes or burdens beyond routine care processes), informed consent was not necessary. Results | We identified 124 urologists from 13 practices who managed 2643 men (median age, 64 years) diagnosed as having low-risk prostate cancer during the interval of interest. The