Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

Abstract

Purpose To endorse Cancer Care Ontario’s guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations. Methods The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommendations. Results The ASCO Endorsement Panel determined that the recommendations from the Active Surveillance for the Management of Localized Prostate Cancer guideline, published in May 2015, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Active Surveillance for the Management of Localized Prostate Cancer guideline with added qualifying statements. The Cancer Care Ontario recommendation regarding 5-alpha reductase inhibitors was not endorsed by the ASCO panel. Recommendations For most patients with low-risk (Gleason score ≤ 6) localized prostate cancer, active surveillance is the recommended disease management strategy. Factors including younger age, prostate cancer volume, patient preference, and ethnicity should be taken into account when making management decisions. Select patients with low-volume, intermediate-risk (Gleason 3 + 4 = 7) prostate cancer may be offered active surveillance. Active surveillance protocols should include prostate-specific antigen testing, digital rectal examinations, and serial prostate biopsies. Ancillary radiologic and genomic tests are investigational but may have a role in patients with discordant clinical and/or pathologic findings. Patients who are reclassified to a higher-risk category (Gleason score ≥ 7) or who have significant increases in tumor volume on subsequent biopsies should be offered active therapy.

Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer

“…In addition, with increasing recognition that many patients may not need treatment immediately, active surveillance is now a standard option, 5 which preserves QOL for an unknown period for each man, until treatment is needed at the time of cancer progression. The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) is a populationbased, observational cohort of men with newly diagnosed prostate cancer who were all enrolled prior to treatment and followed prospectively.…”

One is the new six: The International Society of Urological Pathology (ISUP) patient-focused approach to Gleason grading

“…The documentation of percentage pattern 4 is particularly important in ISUP grade 2 cancers, as the active surveillance guideline published by Cancer Care Ontario and subsequently endorsed by the American Society of Clinical Oncology, indicates that selected patients with Gleason 7 tumours who have ≤10% pattern 4 tumour, can be considered for active surveillance protocols. 29,30 The documentation of percent pattern 4 in Gleason 7 cancers is also recently recommended by the WHO. 31 The grade 4 category of the ISUP grading system is heterogeneous and consists predominantly of tumours with Gleason score 4 + 4 = 8, with less common Gleason patterns 3 + 5 and 5 + 3 also being included.…”

Prostat Kanser Patolojisi

“…Tümörü oluşturan yüksek dereceli (Gleason patern 4 veya 5) prostat kanserinin yüzde-si önemli bir prognostik göstergedir [27,28] [29,30].…”