학술논문
Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer-A Report of a Movember International Consensus Meeting.
Document Type
Academic Journal
Author
Moore CM; Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK. Electronic address: caroline.moore@ucl.ac.uk.; King LE; Movember, Richmond, Victoria, Australia.; Withington J; Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.; Amin MB; Department of Pathology and Lab Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Urology, USC Keck School of Medicine, Los Angeles, CA, USA.; Andrews M; Patient Advocate, England, UK.; Briers E; Patient Advocate, Hasselt, Belgium.; Chen RC; Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA.; Chinegwundoh FI; Department of Urology, Barts Health NHS Trust, London, UK; City University of London, London, UK.; Cooperberg MR; Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Urology, University of California at San Francisco, San Francisco, CA, USA.; Crowe J; Australian Prostate Centre, North Melbourne, Victoria, Australia.; Finelli A; Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada.; Fitch MI; Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.; Frydenberg M; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia.; Giganti F; Division of Surgical and Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.; Haider MA; Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.; Freeman J; Patient Advocate, England, UK.; Gallo J; Active Surveillance Patients International, East Stroudsburg, PA, USA.; Gibbs S; Patient Advocate, England, UK.; Henry A; The Walnut Foundation, Brampton, ON, Canada.; James N; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.; Kinsella N; Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Royal Marsden Hospital, London, UK.; Lam TBL; Academic Urology Unit, Aberdeen University, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.; Lichty M; Active Surveillance Patients International, East Stroudsburg, PA, USA.; Loeb S; Department of Urology, New York University, New York, NY, USA; Department of Population Health, New York University, New York, NY, USA; Manhattan Veterans Affairs Medical Center, New York, NY, USA.; Mahal BA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.; Mastris K; Tackle Prostate Cancer, London UK.; Mitra AV; Cancer Services, University College London Hospitals, NHS, London, UK.; Merriel SWD; Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK; Centre for Primary Care & Health Services Research, University of Manchester, Manchester, UK.; van der Kwast T; Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.; Van Hemelrijck M; Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK.; Palmer NR; Department of Medicine, Zuckerberg San Francisco General Hospital. University of California San Francisco School of Medicine; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco; Department of Urology, University of California San Francisco School of Medicine, San Francisco, CA, USA.; Paterson CC; School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Canberra Health Services and ACT Health, Synergy Nursing and Midwifery Research Centre, Canberra Hospital, Garran, Australian Capital Territory, Australia.; Roobol MJ; Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.; Segal P; Prostate Cancer Support Toronto, Toronto, ON, Canada.; Schraidt JA; ZERO - The End of Prostate Cancer, Alexandria, VA, USA.; Short CE; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia; Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Victoria, Australia.; Siddiqui MM; Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.; Tempany CMC; Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.; Villers A; Department of Urology Univ. Lille, CHU Lille, Department of Urology F-59000 Lille, France.; Wolinsky H; Answer Cancer Foundation, Tumacacori, Arizona, USA; TheActiveSurveillor.com, Flossmoor, Illinois, USA.; MacLennan S; Academic Urology Unit, Aberdeen University, Aberdeen, UK.
Source
Publisher: Elsevier B.V Country of Publication: Netherlands NLM ID: 101724904 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2588-9311 (Electronic) Linking ISSN: 25889311 NLM ISO Abbreviation: Eur Urol Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Active surveillance (AS) is recommended for low-risk and some intermediate-risk prostate cancer. Uptake and practice of AS vary significantly across different settings, as does the experience of surveillance-from which tests are offered, and to the levels of psychological support.
Objective: To explore the 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 health care 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 were 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 the use of high-quality magnetic resonance imaging (MRI), which allows digital rectal examination (DRE) to be omitted, that repeat standard biopsy can be omitted when MRI and prostate-specific antigen (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 AS approach, reducing testing for those at the 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: The current best practice in AS includes the 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 AS for prostate cancer.
Patient Summary: A diverse group of experts in active surveillance, including a broad range of health care professionals and researchers and those with lived experience of prostate cancer, agreed that best practice includes the use of high-quality magnetic resonance imaging, which can allow digital rectal examination and some biopsies to be omitted. The highest research priority in active surveillance research was identified as the development of a dynamic, risk-adjusted approach.
(Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
Objective: To explore the 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 health care 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 were 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 the use of high-quality magnetic resonance imaging (MRI), which allows digital rectal examination (DRE) to be omitted, that repeat standard biopsy can be omitted when MRI and prostate-specific antigen (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 AS approach, reducing testing for those at the 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: The current best practice in AS includes the 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 AS for prostate cancer.
Patient Summary: A diverse group of experts in active surveillance, including a broad range of health care professionals and researchers and those with lived experience of prostate cancer, agreed that best practice includes the use of high-quality magnetic resonance imaging, which can allow digital rectal examination and some biopsies to be omitted. The highest research priority in active surveillance research was identified as the development of a dynamic, risk-adjusted approach.
(Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)