Semantics in active surveillance for men with localized prostate cancer — results of a modified Delphi consensus procedure

Abstract

| Active surveillance (AS) is broadly described as a management option for men with low-risk prostate cancer, but semantic heterogeneity exists in both the literature and in guidelines. To address this issue, a panel of leading prostate cancer specialists in the field of AS participated in a consensus-forming project using a modified Delphi method to reach international consensus on definitions of terms related to this management option. An iterative three-round sequence of online questionnaires designed to address 61 individual items was completed by each panel member. Consensus was considered to be reached if ≥70% of the experts agreed on a definition. To facilitate a common understanding among all experts involved and resolve potential ambiguities, a face-to-face consensus meeting was held between Delphi survey rounds two and three. Convenience sampling was used to construct the panel of experts. In total, 12 experts from Australia, France, Finland, Italy, the Netherlands, Japan, the UK, Canada and the USA participated. By the end of the Delphi process, formal consensus was achieved for 100% (n = 61) of the terms and a glossary was then developed. Agreement between international experts has been reached on relevant terms and subsequent definitions regarding AS for patients with localized prostate cancer. This standard terminology could support multidisciplinary communication, reduce the extent of variations in clinical practice and optimize clinical decision making.312 | MAY 2017 | VOLUME 14 www.nature.com/nrurol CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .degree of monitoring than those on AS might receive, and in which palliative treatment is generally instituted if metastases or local symptoms develop. Interpreting and comparing research results is difficult owing to the nonstandardized use of the terms AS and WW and their intended and often mixed treatment objectives (curative or palliative) 5 . This semantic heterogeneity is also reflected in AS guidelines 6 . In these guidelines, AS is primarily recommended for patients with low-risk tumours; however, these guidelines contain various definitions of low-risk prostate cancer, as specified by different combinations of clinical criteria including clinical and pathological characteristics (such as tumour stage, serum PSA levels, biopsy Gleason score, tumour volume and serum PSA density). Furthermore, definitions of disease reclassification and progression differ among published guidelines and multiple criteria for initiation of curative treatment are proposed 6 .Problems resulting from the use of ambiguous language include hindered clinical decision making, particularly in multidisciplinary collaborations, and limited opportunities for research 7 . Moreover, such ambiguity has raised a barrier that hampers exchange of knowledge within and between fundamental domains of research and research groups 8 . An urgent need exists for uniform...

Progression and treatment rates using an active surveillance protocol incorporating image‐guided baseline biopsies and multiparametric magnetic resonance imaging monitoring for men with favourable‐risk prostate cancer

“…The importance of detecting early grade progression is of course debatable, as is the significance of detecting increased core involvement or core positivity. There is no current national or international standard on this, and grade progression remains a key marker of progression in AS [30].…”

EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study)

“…Thresholds regarding what constituted "consensus agreement" and "consensus disagreement" were specified a priori [8]. "Consensus agreement" was defined as 70% of participants scoring a statement as "strongly agree" (7)(8)(9) and <15% of participants scoring as "strongly disagree" (1)(2)(3). Conversely, "consensus disagreement" was defined as statements scored as "strongly disagree" (score 1-3) by 70% of participants and "strongly agree" by <15% of participants (7)(8)(9).…”

“…Our results may be juxtaposed with those of other studies with overlapping aims. Bruinsma et al [7] used consensus methods to develop statements for active surveillance primarily aimed at standardising terms and definitions. The authors published a list of 61 items as a glossary of terms and definitions, whereas our study provides practical guidance for programmes of DAT.…”

“…In short, there is uncertainty regarding the definition of eligible patients and the optimum follow-up strategies. Although attempts have been made to standardise definitions and terminology via consensus methods [7], there have been no successful projects that harness clinical and patient expertise aiming to standardise practice comprehensively.…”

Best practice in active surveillance for men with prostate cancer: a Prostate Cancer UK consensus statement

“…GAP3 aims to use the data gathered from this cohort to inform AS guidelines internationally on the selection and monitoring of patients with low‐risk prostate cancer. The group has also published an expert consensus document on the semantics used in AS, to facilitate international discussion .…”