Active surveillance for prostate cancer: a narrative review of clinical guidelines

In the past decade active surveillance (AS) of men with localized prostate cancer has become an increasingly popular management option, and a range of clinical guidelines have been published on this topic.

Existing guidelines regarding AS for prostate cancer vary widely, but predominantly state that the most suitable patients for AS are those with pretreatment clinical stage T1c or T2 tumours, serum PSA levels <10 ng/ml, biopsy Gleason scores of 6 or less, a maximum of one or two tumour-positive biopsy core samples and/or a maximum of 50% of cancer per core sample. Following initiation of an AS programme, most guidelines recommend serial serum PSA measurements, digital rectal examinations and surveillance biopsies to check for and identify pathological indications of tumour progression. Definitions of disease reclassification and progression differ among guidelines and multiple criteria for initiation of definitive treatment are proposed. The variety of descriptions of criteria for clinically insignificant prostate cancer indicates a lack of consensus on optimal AS and intervention thresholds. A single set of guidelines are needed in order to reduce variations in clinical practice and to optimize clinical decision-making. To enable truly evidence-based guidelines, further research that combines existing evidence, while also gathering information from more long-term studies is needed.

Nature reviews. Urology. 2016 Jan 27 [Epub ahead of print]

Sophie M Bruinsma, Chris H Bangma, Peter R Carroll, Michael S Leapman, Antti Rannikko, Neophytos Petrides, Mahesha Weerakoon, Leonard P Bokhorst, Monique J Roobol, Movember GAP3 consortium

Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands. , Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands. , Department of Urology, 550 16th Street, University of California, San Francisco, Mailbox Code 1695, San Francisco, California 94143, USA. , Department of Urology, 550 16th Street, University of California, San Francisco, Mailbox Code 1695, San Francisco, California 94143, USA. , Department of Urology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland. , Urology Research, University College London &University College London Hospitals Trust, 132 Hampstead Road, London NW1 2PS, UK. , Austin Hospital, Department of Surgery, Level 8 Harold Stokes Building, 145 Studley Road, Heidelberg, Victoria 3084, Australia. , Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands. , Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.

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