Moore Caroline M, King Lauren E, Withington John, Amin Mahul B, Andrews Mark, Briers Erik, Chen Ronald C, Chinegwundoh Francis I, Cooperberg Matthew R, Crowe Jane, Finelli Antonio, Fitch Margaret I, Frydenberg Mark, Giganti Francesco, Haider Masoom A, Freeman John, Gallo Joseph, Gibbs Stephen, Henry Anthony, James Nicholas, Kinsella Netty, Lam Thomas B L, Lichty Mark, Loeb Stacy, Mahal Brandon A, Mastris Ken, Mitra Anita V, Merriel Samuel W D, van der Kwast Theodorus, Van Hemelrijck Mieke, Palmer Nynikka R, Paterson Catherine C, Roobol Monique J, Segal Phillip, Schraidt James A, Short Camille E, Siddiqui M Minhaj, Tempany Clare M C, Villers Arnaud, Wolinsky Howard, MacLennan Steven
Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
Movember, Richmond, Victoria, Australia.
Eur Urol Oncol. 2023 Apr;6(2):160-182. doi: 10.1016/j.euo.2023.01.003. Epub 2023 Jan 27.
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.
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.
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.
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.
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.
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.
对于低风险和部分中风险前列腺癌，推荐采用主动监测（AS）。不同地区AS的采用情况和实施方式差异显著，监测的经验也有所不同，包括提供哪些检测以及心理支持的水平。
探索前列腺癌AS的当前最佳实践，并确定最重要的研究重点。
设计、设置和参与者：采用正式的共识流程，组建了一个国际专家小组，有目的地抽取了一系列医疗保健专业人员、研究人员以及有前列腺癌亲身经历的人员。编写了关于AS实践以及从监测到开始治疗的患者全程潜在研究重点的陈述。
小组成员用李克特量表对每条陈述进行评分。在小组讨论和重新评分之前，向参与者展示了小组中位数得分和共识度量。确定了当前最佳实践和未来研究重点，并经小组成员商定，最终进行了排序。
达成的共识是，最佳实践包括使用高质量的磁共振成像（MRI），这样可以省略直肠指检（DRE）；当MRI和前列腺特异性抗原（PSA）动力学稳定时，可以省略重复的标准活检；PSA或DRE的变化应促使进行MRI ±活检，而不是立即进行积极治疗。排名最高的研究重点是一种动态的、风险调整的AS方法，减少对进展风险最低者的检测。改进监测中使用的检测方法、确保不同患者和地区在获取和体验方面的公平性，以及改善临床医生与患者之间以及内部的信息和沟通也是高度优先事项。局限性包括出于实际原因使用的小组成员数量有限。
AS的当前最佳实践包括使用高质量MRI以避免DRE，并作为PSA变化的首次评估，当PSA和MRI稳定时省略重复的标准活检。开发一种强大的、动态的、风险适应性的监测方法是前列腺癌AS研究中最高的研究重点。
一群多元化的主动监测专家，包括广泛的医疗保健专业人员、研究人员以及有前列腺癌亲身经历的人员，一致认为最佳实践包括使用高质量的磁共振成像，这可以省略直肠指检和一些活检。主动监测研究中排名最高的研究重点被确定为开发一种动态的、风险调整的方法。
