Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer-A Report of a Movember International Consensus Meeting

Caroline M Moore; 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; John Freeman; Joseph Gallo; Stephen Gibbs; Anthony Henry; Nicholas James; Netty Kinsella; Thomas B L Lam; Mark Lichty; Stacy Loeb; Brandon A Mahal; Ken Mastris; Anita V Mitra; Samuel W D Merriel; Theodorus van der Kwast; Mieke Van Hemelrijck; Nynikka R Palmer; Catherine C Paterson; Monique J Roobol; Phillip Segal; James A Schraidt; Camille E Short; M Minhaj Siddiqui; Clare M C Tempany; Arnaud Villers; Howard Wolinsky; Steven MacLennan

doi:10.1016/j.euo.2023.01.003

Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer-A Report of a Movember International Consensus Meeting

Eur Urol Oncol. 2023 Apr;6(2):160-182. doi: 10.1016/j.euo.2023.01.003. Epub 2023 Jan 27.

Authors

Caroline M Moore¹, Lauren E King², John Withington³, Mahul B Amin⁴, Mark Andrews⁵, Erik Briers⁶, Ronald C Chen⁷, Francis I Chinegwundoh⁸, Matthew R Cooperberg⁹, Jane Crowe¹⁰, Antonio Finelli¹¹, Margaret I Fitch¹², Mark Frydenberg¹³, Francesco Giganti¹⁴, Masoom A Haider¹⁵, John Freeman⁵, Joseph Gallo¹⁶, Stephen Gibbs⁵, Anthony Henry¹⁷, Nicholas James¹⁸, Netty Kinsella¹⁹, Thomas B L Lam²⁰, Mark Lichty¹⁶, Stacy Loeb²¹, Brandon A Mahal²², Ken Mastris²³, Anita V Mitra²⁴, Samuel W D Merriel²⁵, Theodorus van der Kwast²⁶, Mieke Van Hemelrijck²⁷, Nynikka R Palmer²⁸, Catherine C Paterson²⁹, Monique J Roobol³⁰, Phillip Segal³¹, James A Schraidt³², Camille E Short³³, M Minhaj Siddiqui³⁴, Clare M C Tempany³⁵, Arnaud Villers³⁶, Howard Wolinsky³⁷, Steven MacLennan³⁸

Affiliations

¹ 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.
² Movember, Richmond, Victoria, Australia.
³ Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
⁴ 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.
⁵ Patient Advocate, England, UK.
⁶ Patient Advocate, Hasselt, Belgium.
⁷ Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA.
⁸ Department of Urology, Barts Health NHS Trust, London, UK; City University of London, London, UK.
⁹ 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.
¹⁰ Australian Prostate Centre, North Melbourne, Victoria, Australia.
¹¹ 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.
¹² Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
¹³ 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.
¹⁴ Division of Surgical and Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
¹⁵ 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.
¹⁶ Active Surveillance Patients International, East Stroudsburg, PA, USA.
¹⁷ The Walnut Foundation, Brampton, ON, Canada.
¹⁸ Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
¹⁹ 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.
²⁰ Academic Urology Unit, Aberdeen University, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
²¹ 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.
²² Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
²³ Tackle Prostate Cancer, London UK.
²⁴ Cancer Services, University College London Hospitals, NHS, London, UK.
²⁵ Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK; Centre for Primary Care & Health Services Research, University of Manchester, Manchester, UK.
²⁶ Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
²⁷ Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK.
²⁸ 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.
²⁹ 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.
³⁰ Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
³¹ Prostate Cancer Support Toronto, Toronto, ON, Canada.
³² ZERO - The End of Prostate Cancer, Alexandria, VA, USA.
³³ Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia; Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Victoria, Australia.
³⁴ Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
³⁵ Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
³⁶ Department of Urology Univ. Lille, CHU Lille, Department of Urology F-59000 Lille, France.
³⁷ Answer Cancer Foundation, Tumacacori, Arizona, USA; TheActiveSurveillor.com, Flossmoor, Illinois, USA.
³⁸ Academic Urology Unit, Aberdeen University, Aberdeen, UK.

PMID: 36710133
DOI: 10.1016/j.euo.2023.01.003

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.

Keywords: Active surveillance; Prostate cancer; Risk-adapted surveillance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Consensus
Humans
Male
Prostate-Specific Antigen*
Prostatic Neoplasms* / diagnosis
Prostatic Neoplasms* / pathology
Prostatic Neoplasms* / therapy
Research
Watchful Waiting / methods

Substances

Prostate-Specific Antigen