Active surveillance for low-risk prostate cancer: diversity of practice across Europe

Azmi, A.; Dillon, Ruth; Borghesi, Simona; Dunne, Mary; Power, Richard E.; Marignol, Laure; O’Neill, Brian

doi:10.1007/s11845-014-1104-5

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…Currently, the physician’s recommendation has the biggest influence on a patient’s decision to select AS [ 4 , 8 , 12 ]. Variation in AS management is frequently attributed to the physician’s perspectives, practice patterns, or abilities to effectively communicate the merits of AS [ 13 ]. Despite their influential role, physicians receive little to no training in counseling patients on AS [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Describing perspectives of health care professionals on active surveillance for the management of prostate cancer

Pang

Fitch

Ouellet

et al. 2018

BMC Health Serv Res

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BackgroundOver the last decade, active surveillance has proven to be a safe approach for patients with low-risk prostate cancer. Although active surveillance presents several advantages for both patients and the health care system, all eligible patients do not adopt this approach. Our goal was to evaluate the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach.MethodsFocus groups (n = 5) were held with physicians who provided care for men with low-risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of health care professionals (HCPs) was captured to understand their decisions in proposing active surveillance and to reveal the barriers and facilitators that affect the adherence to this approach. A content analysis was performed on the verbatim transcripts from the sessions.ResultsAlthough physicians agreed that active surveillance is a suitable approach for low-risk prostate cancer patients, they were concerned about the rapidly evolving and non-standardized guidelines for patient follow-up. They pointed out the need for additional tools to appropriately identify proper patients for whom active surveillance is the best option. Urologists and radiation-oncologists were keen to collaborate with each other, but the role of general practitioner remained controversial once patients were referred to a specialist.ConclusionsIntegration of more reliable tools and/or markers in addition to more specific guidelines for patient follow-up would increase the confidence of both patients and physicians in the choice of active surveillance.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3273-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Describing perspectives of health care professionals on active surveillance for the management of prostate cancer

Pang

Fitch

Ouellet

et al. 2018

BMC Health Serv Res

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“…Findings of a study conducted by Azmi et al 34 in 2013 showed that a relatively high level of agreement exists between the conclusions of various studies of AS that patients with serum PSA levels ≤10 ng/ml and a biopsy sample Gleason score of ≤3+3 = 6 are appropriate for AS, although, clearly less agreement exists in terms of the most appropriate clinical tumour stage, number of tumour-positive biopsy core samples and patient age 34 . Furthermore, little consensus exists in the literature regarding how to optimally assess progression of localized prostate cancer; although, the majority of studies used serial measurements of serum PSA levels and DRE, with some also adding prostate biopsy sampling 34 . No consensus has been reached regarding the frequency of repeat investigations or on the most appropriate triggers for initiation of radical treatment across the various AS programmes 34 .…”

Section: [H2] Increase In Tumour Volumementioning

confidence: 99%

“…Furthermore, little consensus exists in the literature regarding how to optimally assess progression of localized prostate cancer; although, the majority of studies used serial measurements of serum PSA levels and DRE, with some also adding prostate biopsy sampling 34 . No consensus has been reached regarding the frequency of repeat investigations or on the most appropriate triggers for initiation of radical treatment across the various AS programmes 34 . To enable truly evidencebased guidelines to be issued, further research that combines existing evidence whilst also gathering information from more long-term studies is needed.…”

Section: [H2] Increase In Tumour Volumementioning

confidence: 99%

Active surveillance for prostate cancer: a narrative review of clinical guidelines

et al. 2016

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In the past decade active surveillance (AS) of men with localized prostate cancer has become an increasingly popular management option, and a range of clinical guidelines have been published on this topic. Existing guidelines regarding AS for prostate cancer vary widely, but predominantly state that the most suitable patients for AS are those with pretreatment clinical stage T1c or T2 tumours, serum PSA levels <10 ng/ml, biopsy Gleason scores of 6 or less, a maximum of one or two tumour-positive biopsy core samples and/or a maximum of 50% of cancer per core sample. Following initiation of an AS programme, most guidelines recommend serial serum PSA measurements, digital rectal examinations and surveillance biopsies to check for and identify pathological indications of tumour progression. Definitions of disease reclassification and progression differ among guidelines and multiple criteria for initiation of definitive treatment are proposed. The variety of descriptions of criteria for clinically insignificant prostate cancer indicates a lack of consensus on optimal AS and intervention thresholds. A single set of guidelines are needed in order to reduce variations in clinical practice and to optimize clinical decision-making. To enable truly evidence-based guidelines, further research that combines existing evidence, while also gathering information from more long-term studies is needed.

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“…7 8 Furthermore, a large diversity of practice across Europe has recently been reported, showing that urologists who are not participating in a clinical trial appear to apply less rigorous criteria for both inclusion and follow-up (FU). 9 In 1999, we began a prospective AS clinical trial in our average-sized clinic with the intention of assessing the outcome of patients with PCa managed with AS. We hoped this study would provide insight into a real-world application of AS in a smaller non-academic hospital in the European setting.…”

Section: Introductionmentioning

confidence: 99%

Acknowledging unreported problems with active surveillance for prostate cancer: a prospective single-centre observational study

2016

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ObjectiveTo report outcomes of patients with localised prostate cancer (PCa) managed with active surveillance (AS) in a standard clinical setting.DesignSingle-centre, prospective, observational study.SettingNon-academic, average-size hospital in Switzerland.ParticipantsProspective, observational study at a non-academic, average-size hospital in Switzerland. Inclusion and progression criteria meet general recommendations. 157 patients at a median age of 67 (61–70) years were included from December 1999 to March 2012. Follow-up (FU) ended June 2013.ResultsMedian FU was 48 (30–84) months. Overall confirmed reclassification rate was 20% (32/157). 20 men underwent radical prostatectomy with 1 recurrence, 11 had radiation therapy with 2 prostate-specific antigen relapses, and 1 required primary hormone ablation with a fatal outcome. Kaplan-Meier estimates for those remaining in the study showed an overall survival of 92%, cancer-specific survival of 99% and reclassification rate of 41%. Dropout rate was 36% and occurred at a median of 48 (21–81) months after inclusion. 68 (43%) men are still under AS.ConclusionsCareful administration of AS can and will yield excellent results in long-term management of PCa, and also helps physicians and patients alike to balance quality of life and mortality. Our data revealed significant dropout from FU. Patient non-compliance can be a relevant problem in AS.

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Active surveillance for low-risk prostate cancer: diversity of practice across Europe

Abstract: Urologists not adhering to an AS protocol or participating in a clinical trial appear to apply less rigorous criteria for both eligibility and monitoring in AS.

Cited by 9 publications

References 25 publications

Describing perspectives of health care professionals on active surveillance for the management of prostate cancer

Describing perspectives of health care professionals on active surveillance for the management of prostate cancer

Active surveillance for prostate cancer: a narrative review of clinical guidelines

Acknowledging unreported problems with active surveillance for prostate cancer: a prospective single-centre observational study

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