Abstract
Background: There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised.
Objective: To develop consensus statements for all domains of DAT. Design, setting and participants: A protocol-driven, 3-phase study undertaken by the EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel in conjunction with partner organisations, including: (1) A systematic review to describe heterogeneity across all domains; (2) A 2-round Delphi survey involving a large, international panel of stakeholders, including healthcare practitioners (HCPs) and patients; and (3) A consensus group meeting attended by stakeholder group representatives. Robust methods regarding what constituted consensus were strictly followed.
Results and limitations: 109 HCPs and 16 patients completed both survey rounds. Of 129 statements in the survey, consensus was achieved in 66 (51%); the rest of the statements were discussed and voted on in the consensus meeting by 32 HCPs and 3 patients, where consensus was achieved in an additional 27 statements (43%). Overall, 93 statements (72%) achieved consensus in the project. Some uncertainties remained regarding clinically important thresholds for disease extent on biopsy in low risk disease, and the role of mpMRI in determining disease stage and aggressiveness as a criterion for inclusion and exclusion.
Conclusions: Consensus statements and the findings are expected to guide and inform routine clinical practice and research, until higher levels of evidence emerge through prospective comparative studies and clinical trials.
Patient summary: We undertook a project aimed at standardising elements of practice in active surveillance programmes for early localised prostate cancer because currently there is great variation and uncertainty regarding how best to conduct them. The project involved large numbers of healthcare practitioners and patients using a survey and face-to-face meeting, in order to achieve agreement (i.e. consensus) regarding best practice, which will provide guidance to clinicians and researchers.
Objective: To develop consensus statements for all domains of DAT. Design, setting and participants: A protocol-driven, 3-phase study undertaken by the EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel in conjunction with partner organisations, including: (1) A systematic review to describe heterogeneity across all domains; (2) A 2-round Delphi survey involving a large, international panel of stakeholders, including healthcare practitioners (HCPs) and patients; and (3) A consensus group meeting attended by stakeholder group representatives. Robust methods regarding what constituted consensus were strictly followed.
Results and limitations: 109 HCPs and 16 patients completed both survey rounds. Of 129 statements in the survey, consensus was achieved in 66 (51%); the rest of the statements were discussed and voted on in the consensus meeting by 32 HCPs and 3 patients, where consensus was achieved in an additional 27 statements (43%). Overall, 93 statements (72%) achieved consensus in the project. Some uncertainties remained regarding clinically important thresholds for disease extent on biopsy in low risk disease, and the role of mpMRI in determining disease stage and aggressiveness as a criterion for inclusion and exclusion.
Conclusions: Consensus statements and the findings are expected to guide and inform routine clinical practice and research, until higher levels of evidence emerge through prospective comparative studies and clinical trials.
Patient summary: We undertook a project aimed at standardising elements of practice in active surveillance programmes for early localised prostate cancer because currently there is great variation and uncertainty regarding how best to conduct them. The project involved large numbers of healthcare practitioners and patients using a survey and face-to-face meeting, in order to achieve agreement (i.e. consensus) regarding best practice, which will provide guidance to clinicians and researchers.
| Original language | English |
|---|---|
| Pages (from-to) | 790-813 |
| Number of pages | 24 |
| Journal | European Urology |
| Volume | 76 |
| Issue number | 6 |
| Early online date | 3 Oct 2019 |
| DOIs | |
| Publication status | Published - 1 Dec 2019 |
Bibliographical note
The authors are grateful to the following individuals and organisations for the following contributions: R. Bryan Rumble, MSc for reviewing and commenting on the manuscript; American Society of Clinical Oncology (ASCO) for providing members who participated in the survey and consensus group meeting; IPSEN for providing an unrestricted educational grant; however IPSEN did not have any access to the study data nor did they have any control over the final manuscript; European Association of Urology (EAU) for providing an unrestricted educational grant; however the EAU did not have any access to the data nor did they have any control over the final manuscript.Keywords
- Deferred treatment with curative intent
- Active surveillance and monitoring
- Localised prostate cancer
- Eligibility
- Follow-up
- Reclassification
- Outcome measures
- Consensus statements
- Delphi survey
- Consensus group meeting
- Clinical practice guidelines
Access to Document
- Accepted manuscript
© 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
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Steven MacLennan
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Senior Research Fellow
- Institute of Applied Health Sciences
- Academic Urology Unit
Person: Academic Related - Research