Active surveillance (AS) is recommended for low risk, and some intermediate risk prostate cancer. Uptake and practice of AS varies significantly across different settings, as does the experience of surveillance – from which tests are offered, and when, to levels of psychological support.
To explore 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 healthcare 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 was 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 use of high quality MRI which allows DRE to be omitted, that repeat standard biopsy can be omitted when MRI and 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 active surveillance approach, reducing testing for those at 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.
Current best practice in active surveillance includes 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 active surveillance for prostate cancer.
Bibliographical noteFunding/Support and role of the sponsor: This work was supported by Movember.
Acknowledgements: We gratefully acknowledge the contribution of Jane Fisher of Movember in reviewing the manuscript and Professor James N'Dow in commenting on the first round of the questionnaire.