College of Medicine and Health, University of Exeter, 1.18 College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
Department of Surgery, University of Melbourne, Melbourne, Australia.
BMC Urol. 2021 Feb 4;21(1):18. doi: 10.1186/s12894-021-00789-5.
Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians from an international panel of prostate cancer experts.
A modified Delphi approach was undertaken, utilising two rounds of online questionnaires followed by a face-to-face workshop. Participants indicated their level of agreement with statements relating to patient selection for AS via online questionnaires on a 7-point Likert scale. Factors not achieving agreement were iteratively developed between the two rounds of questionnaires. Draft statements were presented at the face-to-face workshop for discussion and consensus building.
12 prostate cancer experts (9 urologists, 2 academics, 1 radiation oncologist) participated in this study from a range of geographical regions (4 USA, 4 Europe, 4 Australia). Complete agreement on statements presented to the participants was 29.4% after Round One and 69.0% after Round Two. Following robust discussions at the face-to-face workshop, agreement was reached on the remaining statements. PSA, PSA density, Multiparametric MRI, and systematic biopsy (with or without targeted biopsy) were identified as minimum diagnostic tests required upon which to select patients to recommend AS as a treatment option for prostate cancer. Patient factors and clinical parameters that identified patients appropriate to potentially receive AS were agreed. Genetic and genomic testing was not recommended for use in clinical decision-making regarding AS.
The lack of consistency in the practice of AS for men with lower risk prostate cancer between and within countries was reflected in this modified Delphi study. There are, however, areas of common practice and agreement from which clinicians practicing in the current environment can use to inform their clinical practice to achieve the best outcomes for patients.
主动监测（AS）是一种管理低危前列腺癌患者的选择。从患者选择到检查和随访间隔，AS 在国际上的各个方面都存在很大差异，而且缺乏关于 AS 最佳方法的明确证据。本研究旨在为国际前列腺癌专家小组的临床医生提供指导。
采用改良 Delphi 方法，通过两轮在线问卷和一次面对面研讨会进行。参与者通过在线问卷在 7 点李克特量表上对与 AS 患者选择相关的陈述表示同意程度。两轮问卷之间反复出现未达成一致的因素。草案陈述在面对面研讨会上提出，供讨论和达成共识。
本研究共有 12 名前列腺癌专家（9 名泌尿科医生、2 名学者和 1 名放射肿瘤学家）参与，他们来自不同的地理区域（4 名来自美国，4 名来自欧洲，4 名来自澳大利亚）。第一轮后，向参与者提出的陈述完全一致的比例为 29.4%，第二轮后为 69.0%。在面对面研讨会进行了激烈的讨论后，其余陈述也达成了一致。PSA、PSA 密度、多参数 MRI 和系统活检（有或无靶向活检）被确定为选择推荐 AS 作为前列腺癌治疗选择的患者所需的最低诊断测试。达成一致的还有适合接受 AS 的患者的因素和临床参数。未推荐对遗传和基因组检测用于 AS 临床决策。
这项改良 Delphi 研究反映了各国之间和各国国内低危前列腺癌患者 AS 实践的不一致性。然而，存在一些共同的实践和共识领域，当前环境下的临床医生可以利用这些领域来为患者提供最佳治疗效果。
