Best current practice and research priorities in active surveillance for prostate cancer: report of a Movember international consensus meeting

Caroline M Moore* (Corresponding Author), Lauren E King, John Withington, Mahul B Amin, Mark Andrews, Erik Briers, Ronald C Chen, Francis I Chinegwundoh, Matthew R Cooperberg, Jane Crowe, Antonio Finelli, Margaret I Fitch, Mark Frydenberg, Francesco Giganti, Masoom A Haider, Masoom A Haider, Joseph Gallo, Stephen Gibbs, Anthony Henry, Nicholas JamesNetty Kinsella, Thomas Lam, Mark Lichty, Stacy Loeb, Brandon A Mahal, Ken Mastris, Anita V Mitra, Samuel W D Merriel, Theodorus H. van der Kwast, Mieke Van Hemelrijck, Nynikka R Palmer, Catherine Paterson, Monique J Roobol, Phillip Segal, James A Schraidt, Camille E Short, M Minhaj Siddiqu, Clare M C Tempany, Arnaud Villers, Howard Wolinsky, Steven MacLennan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background

Active surveillance (AS) is recommended for low risk, and some intermediate risk prostate cancer. Uptake and practice of AS varies significantly across different settings, as does the experience of surveillance – from which tests are offered, and when, to levels of psychological support.

Objective

To explore current best practice and determine the most important research priorities in AS for prostate cancer.

Design, setting and participants

A formal consensus process was followed, with an international expert panel of purposively sampled participants across a range of healthcare professionals and researchers, and those with lived experience of prostate cancer. Statements regarding the practice of AS and potential research priorities spanning the patient journey from surveillance to initiating treatment were developed.

Outcome measurements and statistical analysis

Panel members scored each statement on a Likert scale. The group median score and measure of consensus was presented to participants prior to discussion and rescoring at panel meetings. Current best practice and future research priorities were identified, agreed upon and finally ranked by panel members.

Results and limitations

There was consensus agreement that best practice includes use of high quality MRI which allows DRE to be omitted, that repeat standard biopsy can be omitted when MRI and PSA kinetics are stable, and that changes in PSA or DRE should prompt MRI +/- biopsy rather than immediate active treatment.

The highest ranked research priority was a dynamic, risk adjusted active surveillance approach, reducing testing for those at least risk of progression. Improving the tests used in surveillance, ensuring equity of access and experience across different patients and settings, and improving information and communication between and within clinicians and patients were also high priorities.

Limitations include the use of a limited number of panel members for practical reasons.

Conclusions

Current best practice in active surveillance includes use of high quality MRI to avoid DRE, and as the first assessment for changes in PSA, with omission of repeat standard biopsy when PSA and MRI are stable. Development of a robust, dynamic, risk-adapted approach to surveillance is the highest research priority in active surveillance for prostate cancer.
Original languageEnglish
JournalEuropean Urology Oncology
Publication statusAccepted/In press - 7 Jan 2023

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