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

Abstract

Objectives To develop a consensus statement on current best practice of active surveillance (AS) in the UK, informed by patients and clinical experts. Subjects and Methods A consensus statement was drafted on the basis of three sources of data: systematic literature search of national and international guidelines; data arising from a Freedom of Information Act request to UK urology departments regarding their current practice of AS; and survey and interview responses from men with localized prostate cancer regarding their experiences and views of AS. The Prostate Cancer UK Expert Reference Group (ERG) on AS was then convened to discuss and refine the statement. Results Guidelines and protocols for AS varied significantly in terms of risk stratification, criteria for offering AS, and protocols for AS between and within countries. Patients and healthcare professionals identified clinical, emotional and process needs for AS to be effective. Men with prostate cancer wanted more information and psychological support at the time of discussing AS with the treating team and in the first 2 years of AS, and a named healthcare professional to discuss any questions or concerns they had. The ERG agreed 30 consensus statements regarding best practice for AS. Statements were grouped under headings: ‘Inclusion/Exclusion Criteria’; ‘AS follow‐up protocol’ and ‘When to stop AS’. Conclusion Significant variation currently exists in the practice of AS in the UK and internationally. Men have clear views on the level of involvement in treatment decisions and support from their treating professionals when receiving AS. The Prostate Cancer UK AS ERG has developed a set of consensus statements for best practice in AS. Evidence for best practice in AS, and the use of multiparametric magnetic resonance imaging in AS, is still evolving, and further studies are needed to determine how to optimize AS outcomes.

The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK‐wide mixed methods study

“…Following concerns regarding overtreatment, AS is now offered to all men diagnosed with localised, low‐risk PCa, as a way to avoid treatment‐related impairments in urinary, bowel, and sexual functioning . AS is also an option for men with intermediate risk disease . Men on AS typically undergo periodic prostate‐specific antigen (PSA) testing, digital rectal examinations (DRE), MRI scans, and biopsies with a view to moving to radical intervention if the disease progresses .…”

“…[3][4][5] AS is also an option for men with intermediate risk disease. 6 Men on AS typically undergo periodic prostate-specific antigen (PSA) testing, digital rectal examinations (DRE), MRI scans, and biopsies with a view to moving to radical intervention if the disease progresses. 7 Watchful waiting (WW) is another alternative to active treatment (AT), although this is typically offered to older men and/or men with pre-existing health conditions or more advanced PCa.…”

Active surveillance for prostate cancer: an update

“…Communicating risk to patients is an important skill for any clinician, and men faced with the decision about whether to commence active surveillance value clear information about all of their options . The updated NICE guidance employs numerical methods to try to translate population level risks to the individual patient.…”

“…Following an initial consultation, patients will have PSA testing, DRE, and imaging and/or biopsy at regular intervals. The timing and frequency of these monitoring tests, and which tests are done, varies significantly within the UK, and internationally . The recommended protocol from the recently update NICE guidance can be found in Table .…”

NICE guidelines on prostate cancer 2019

“…To reduce variations in active surveillance, Prostate Cancer UK has carefully examined eight different guidelines and published a consensus statement for the benefit of our patients . We have already promoted this widely on social media and hope that our readers will use this practical tool in their clinics.…”