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Sutherland R, Gross CP, Ma X, Jeong F, Seibert TM, Cooperberg MR, Catalona WJ, Ellis SD, Loeb S, Schulman‐Green D, Leapman MS. 'It Just Makes Sense to Me': A qualitative study exploring patient decision-making and experiences with prostate MRI during active surveillance for prostate cancer. BJUI COMPASS 2024; 5:593-601. [PMID: 38873351 PMCID: PMC11168777 DOI: 10.1002/bco2.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Although prostate magnetic resonance imaging (MRI) is commonly used in the diagnosis, staging and active surveillance of prostate cancer, little is known about patient perspectives on MRI. Methods We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- and intermediate-risk prostate cancer managed with active surveillance. Interviews focused on experiences with and knowledge of prostate MRI and MRI-ultrasound fusion biopsy during active surveillance. We purposively sampled patients who received prostate MRI as part of their clinical care, conducted interviews until reaching thematic saturation and performed conventional content analysis to analyse data. Results Twenty patients aged 51-79 years (mean = 68 years) participated in the study. At diagnosis, 17 (85%) had a Gleason grade group 1, and three (15%) had a grade group 2 tumour. Overall, participants viewed prostate MRI as a valuable tool that accurately localizes and monitors prostate cancer over time, and they considered prostate MRI central to active surveillance monitoring. We identified five thematic categories related to MRI use: (1) the experiential aspects of undergoing an MRI scan; (2) the experience of visualizing one's own prostate and prostate cancer; (3) adequacy of provider explanations of MRI results; (4) confidence in prostate MRI in decision-making; and (5) the role of prostate MRI in longitudinal follow-up, including an interest in using MRI to modify the timing of, or replace, prostate biopsy. Conclusion Patients value prostate MRI as a tool that enhances their confidence in the initial diagnosis and monitoring of prostate cancer. This work can inform future studies to optimize patient experience, education and counselling during active surveillance for prostate cancer.
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Affiliation(s)
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Farah Jeong
- Yale School of Public HealthNew HavenConnecticutUSA
| | - Tyler M. Seibert
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of BioengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Matthew R. Cooperberg
- Department of UrologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - William J. Catalona
- Department of UrologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Shellie D. Ellis
- Department of Population Health Kansas University Medical CenterKansas CityKansasUSA
| | - Stacy Loeb
- Departments of Urology and Population HealthNew York University Langone HealthNew YorkUSA
- Manhattan Veterans Affairs Medical CenterNew YorkNew YorkUSA
| | | | - Michael S. Leapman
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Department of UrologyYale School of MedicineNew HavenConnecticutUSA
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2
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Hughes S, Everitt H, Stuart B, Band R. The experiences of men on active surveillance for prostate cancer and their significant others: A qualitative synthesis. Psychooncology 2024; 33:e6324. [PMID: 38570198 DOI: 10.1002/pon.6324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Active surveillance (AS) for prostate cancer (PCa) is a monitoring pathway for men with low-grade, slow growing PCa and aims to delay or avoid active treatment by treating only in the case of disease progression. Experiences of this pathway vary but living with an untreated cancer can have a negative psychological impact on both the patient and their significant other (SO). Literature suggests partners are the primary source of support for men on AS, and therefore it is important to consider SO experiences alongside those of the patient. To the best of our knowledge this is the first UK-based qualitative review looking specifically at experiences of AS for both men with PCa and their SOs. METHODS MEDLINE (Ovid), EMBASE, PsychINFO, CINAHL and Cochrane Library were searched for literature reporting qualitative experiences of AS for PCa for either men on AS or SOs (or both). 2769 records were identified and screened, with 28 meeting the eligibility criteria. Qualitative data were synthesised and included men on AS (n = 428), and SOs (n = 51). RESULTS Experiences of the AS pathway vary but reports of uncertainty and anxiety were present in the accounts of both men on AS and SOs. SOs are intertwined throughout every part of the PCa journey, and couples presented as a unit that were on AS together. Both patients and SOs expressed a need for more support, and highly valued peer support. Despite this finding, men expressed a dislike towards 'support groups'. CONCLUSIONS Increased recognition in clinical practice of SO involvement in AS is needed. Further research is required to explore the specific types of support that would be most acceptable to this population to address the unmet support needs uncovered in this review.
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Affiliation(s)
- Stephanie Hughes
- Primary Care Research Centre, School of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, Hants, UK
| | - Hazel Everitt
- Primary Care Research Centre, School of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, Hants, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca Band
- Health Sciences, University of Southampton, Southampton, Hants, UK
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Vickers A, O'Brien F, Montorsi F, Galvin D, Bratt O, Carlsson S, Catto JW, Krilaviciute A, Philbin M, Albers P. Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit. BMJ 2023; 381:e071082. [PMID: 37197772 DOI: 10.1136/bmj-2022-071082] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Frank O'Brien
- Department of Urology, Cork University Hospital, Ireland
| | | | - David Galvin
- Department of Surgery, University College Dublin, Ireland
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Sigrid Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - James Wf Catto
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, UK
| | - Agne Krilaviciute
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Peter Albers
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany
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4
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Beckmann K, Cahill D, Brown C, Van Hemelrijck M, Kinsella N. Developing a consensus statement for psychosocial support in active surveillance for prostate cancer. BJUI COMPASS 2023; 4:104-113. [PMID: 36569508 PMCID: PMC9766868 DOI: 10.1002/bco2.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Our objective was to prioritise the psychosocial support needs of men on active surveillance for prostate cancer and to develop a consensus statement to provide guidance on best practice psychosocial support for men choosing active surveillance and their families. Subjects and methods We undertook a patient and public involvement Delphi process over two rounds, informed by qualitative data and a comprehensive literature review, to prioritise the information and support needs of men on active surveillance for prostate cancer. Two panels were surveyed, a patient/carer panel (n = 55) and a health care provider panel (n = 114). Based on the findings of the Delphi surveys, an expert active surveillance discussion group developed a consensus statement to guide best practice. Results Patients and health care professionals differed slightly in their ideas concerning priorities for active surveillance psychosocial support. Broadly, agreed priority areas included -patients being involved in decision-making, continuity of care, more streamlined access to health care teams, improved understanding of the risk of prostate cancer progression and information and support provided through both health care professionals and peers. Based on the identified priorities, the expert discussion group agreed on 22 consensus statements for best practice in psychosocial care for active surveillance in respect of (1) principles of an active surveillance programme; (2) structure of consultations; (3) content of information and support; and (4) delivery of information. Conclusion This consensus statement provides a framework for patient-focused psychosocial support, which, if adopted, should increase uptake and adherence to active surveillance among men with prostate cancer.
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Affiliation(s)
- Kerri Beckmann
- Translational Oncology and Urology Research Kings College London London UK
- Cancer Epidemiology and Population Health Research Group University of South Australia Adelaide South Australia Australia
| | - Declan Cahill
- Department of Urology The Royal Marsden Hospital London UK
| | - Christian Brown
- Urology Department Guy's and St Thomas' NHS Foundation Trust London UK
| | | | - Netty Kinsella
- Department of Urology The Royal Marsden Hospital London UK
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Developing machine learning algorithms for dynamic estimation of progression during active surveillance for prostate cancer. NPJ Digit Med 2022; 5:110. [PMID: 35933478 PMCID: PMC9357044 DOI: 10.1038/s41746-022-00659-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/14/2022] [Indexed: 11/15/2022] Open
Abstract
Active Surveillance (AS) for prostate cancer is a management option that continually monitors early disease and considers intervention if progression occurs. A robust method to incorporate “live” updates of progression risk during follow-up has hitherto been lacking. To address this, we developed a deep learning-based individualised longitudinal survival model using Dynamic-DeepHit-Lite (DDHL) that learns data-driven distribution of time-to-event outcomes. Further refining outputs, we used a reinforcement learning approach (Actor-Critic) for temporal predictive clustering (AC-TPC) to discover groups with similar time-to-event outcomes to support clinical utility. We applied these methods to data from 585 men on AS with longitudinal and comprehensive follow-up (median 4.4 years). Time-dependent C-indices and Brier scores were calculated and compared to Cox regression and landmarking methods. Both Cox and DDHL models including only baseline variables showed comparable C-indices but the DDHL model performance improved with additional follow-up data. With 3 years of data collection and 3 years follow-up the DDHL model had a C-index of 0.79 (±0.11) compared to 0.70 (±0.15) for landmarking Cox and 0.67 (±0.09) for baseline Cox only. Model calibration was good across all models tested. The AC-TPC method further discovered 4 distinct outcome-related temporal clusters with distinct progression trajectories. Those in the lowest risk cluster had negligible progression risk while those in the highest cluster had a 50% risk of progression by 5 years. In summary, we report a novel machine learning approach to inform personalised follow-up during active surveillance which improves predictive power with increasing data input over time.
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Barrett T, Pacey S, Leonard K, Wulff J, Funingana IG, Gnanapragasam V. A Feasibility Study of the Therapeutic Response and Durability of Short-term Androgen-targeted Therapy in Early Prostate Cancer Managed with Surveillance: The Therapeutics in Active Prostate Surveillance (TAPS01) Study. EUR UROL SUPPL 2022; 38:17-24. [PMID: 35495285 PMCID: PMC9051967 DOI: 10.1016/j.euros.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Active surveillance (AS) is a preferred management option for men with prostate cancer with favourable prognosis. However, nearly half of men on AS switch to treatment within 5 years, so therapeutic strategies to prevent or delay disease progression could be considered. The androgen receptor is the pre-eminent oncogenic driver in prostate cancer. Objective To explore image-based tumour responses and the patient impact of short-duration androgen-targeted therapy (ATT) to abrogate disease progression during AS. Design, setting, and participants Men on AS with Cambridge Prognostic Group 1 & 2 (low and favourable intermediate risk) prostate cancer and lesions visible on magnetic resonance imaging (MRI) were recruited to an open-label, single-centre, phase 2 feasibility study of short-term ATT (the TAPS01 study). Intervention Apalutamide 240 mg was administered for 90 days. Outcome measurements and statistical analysis MRI-measured tumour volume (TV), gland volume (GV), and the TV/GV ratio were calculated at baseline, at day 90 (end of treatment), and at 6- and 18-month follow-up. Quality of life metrics were measured at day 0, day 90, and 6 weeks after ATT. Results and limitations Eleven patients (40% of eligible men approached) agreed to participate, of whom nine completed treatment. At day 90, the median percentage reduction was −38.2% (range −51.8% to −23.5%) for GV, −54.2% (range −74.1% to −13.8%) for TV, and −27.2% (range −61.5% to −7.5%) for TV/GV (all p < 0.0001). At 6 mo, while GV had returned to baseline (p = 0.95) both TV (−31.9%; p = 0.0007) and TV/GV (−28.7%; p = 0.0009) remained significantly reduced. This reduction was sustained at 18 months (TV −18%, TV/GV −23.8%; p = 0.01). European Organization for Research and Treatment of Cancer QoL core 30-item questionnaire scores for global, physical, role, and social functioning decreased during treatment, but all were recovering by 6 weeks. EQ-VAS scores were unchanged compared to baseline. Conclusions TAPS01 has demonstrated feasibility and patient tolerability for short-term ATT in men on AS. Our data suggest a selective and durable antitumour effect in the short term and support a larger-scale randomised trial. Patient summary We investigated the feasibility of short-term treatment with an androgen inhibitor to prevent or delay disease progression for men on active surveillance for prostate cancer. Results for a small group of patients show that 90-day treatment led to a sustained decrease in tumour volume over 18 months. The findings warrant a larger clinical trial for this approach, which could allow patients to delay or even avoid longer-term active treatments.
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Affiliation(s)
- Tristan Barrett
- Translational Prostate Cancer Group, CRUK Cambridge Cancer Centre, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Simon Pacey
- Translational Prostate Cancer Group, CRUK Cambridge Cancer Centre, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Kelly Leonard
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke’s Hospital, Cambridge, UK
| | - Jerome Wulff
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge, UK
| | - Ionut-Gabriel Funingana
- Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Vincent Gnanapragasam
- Translational Prostate Cancer Group, CRUK Cambridge Cancer Centre, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke’s Hospital, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Corresponding author. Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke’s Hospital, Keith Day Road, Cambridge CB2 0SL, UK.
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7
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Parker P, Twiddy M, Whybrow P, Rigby A, Simms M. The role of diagnostic ultrasound imaging for patients with known prostate cancer within an active surveillance pathway: A systematic review. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:4-17. [PMID: 35173774 PMCID: PMC8841943 DOI: 10.1177/1742271x21995212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The use of multiparametric magnetic resonance imaging (mpMRI) within active surveillance of prostate cancer programmes is identified by the UK National Institute for Health and Care Excellence (NICE guideline NG 131 2019) as having a role for monitoring disease. The widespread demands on mpMRI capacity may limit its use in surveillance. It is therefore timely to review the options that modern ultrasound imaging present to this cohort of patients in the monitoring of prostate cancer. METHODS Between April and September 2020, 10 databases were searched to recruit studies for the review. Three reviewers evaluated the publications for inclusion. Characteristics including the inclusion criteria for the study cohort, how disease was determined, identification of disease progression, and the modality and mode of imaging used were reviewed. Given the paucity of full text articles, a meta-analysis was not possible. A narrative review was undertaken. RESULTS In total, 12 studies, utilising the range of ultrasound parameters of B-mode, micro-ultrasound, colour Doppler, contrast ultrasound and elastography were included. The review demonstrated that micro-ultrasound offers promise as an imaging tool comparable with mpMRI. However, this is an emerging technology with limited availability. Analysis of the data further demonstrated that by combining the diagnostic features provided by multiple modes reviewed, ultrasound has a role in the diagnostic imaging of patients on active surveillance. CONCLUSION Providing a multiparametric approach is utilised, stable ultrasound findings may allow for increased intervals between biopsy for men on surveillance. The advent of micro-US offers promise as an imaging modality within an active surveillance pathway but requires further verification.
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Affiliation(s)
- Pamela Parker
- Department of Ultrasound, University of Hull & Hull University Teaching Hospitals NHS Trust, Hull, UK,Pamela Parker, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK.
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| | - Paul Whybrow
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| | - Alan Rigby
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| | - Matthew Simms
- Department of Urology, Hull University Teaching Hospitals NHS Trust, Hull, UK
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8
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Hidden clues in prostate cancer - Lessons learned from clinical and pre-clinical approaches on diagnosis and risk stratification. Cancer Lett 2022; 524:182-192. [PMID: 34687792 DOI: 10.1016/j.canlet.2021.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022]
Abstract
The heterogeneity of prostate cancer is evident at clinical, morphological and molecular levels. To aid clinical decision making, a three-tiered system for risk stratification is used to designate low-, intermediate-, and high-risk of disease progression. Intermediate-risk prostate cancers are the most frequently diagnosed, and even with common diagnostic features, can exhibit vastly different clinical progression. Thus, improved risk stratification methods are needed to better predict patient outcomes. Here, we provide an overview of the improvements in diagnosis/prognosis arising from advances in pathology reporting of prostate cancer, which can improve risk stratification, especially for patients with intermediate-risk disease. This review discusses updates to pathology reporting of morphological growth patterns, and proposes the utility of integrating prognostic biomarkers or innovative imaging techniques to enhance clinical decision-making. To complement clinical studies, experimental approaches using patient-derived tumors have highlighted important cellular and morphological features associated with aggressive disease that may impact treatment response. The intersection of urology, pathology and scientific disciplines is required to work towards a common goal of understanding disease pathogenesis, improving the stratification of patients with intermediate-risk disease and subsequently defining optimal treatment strategies using precision-based approaches.
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9
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Lowenstein LM, Choi NJ, Hoffman KE, Volk RJ, Loeb S. Factors that influence clinicians' decisions to decrease active surveillance monitoring frequency or transition to watchful waiting for localised prostate cancer: a qualitative study. BMJ Open 2021; 11:e048347. [PMID: 34772748 PMCID: PMC8593754 DOI: 10.1136/bmjopen-2020-048347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Little is known about clinicians' decision-making about decreasing active surveillance (AS) testing/converting patients to watchful waiting (WW), nor are there any guidelines. The objective of this study was to identify factors that clinicians consider when decreasing AS testing/converting to WW for men with prostate cancer. DESIGN Exploratory qualitative study. SETTING All participants practiced in various institutions in the USA. PARTICIPANTS Eligible clinicians had to provide clinical care for patients with prostate cancer in the USA and speak English. Clinicians could be either urologists or radiation oncologists. Of the 24 clinicians, 83% were urologists representing 11 states, 92% were men and 62% were white. METHODS This qualitative study used data from semi-structured interviews. Purposive sampling was used to ensure geographical variation in the USA. Data collection continued until thematic saturation was achieved. Framework analysis guided coding and identification of themes. Two researchers coded all transcripts independently, met to discuss and reached consensus. RESULTS Interviews with clinicians demonstrated that testing or monitoring for AS or transitioning to WW is happening in practice, whether intentionally or unintentionally. Decisions to decrease AS were personalised and tailored to patients' health status. Life expectancy was the dominant factor that influenced decision, but clinicians were generally hesitant to specify an age when they would decrease AS or transition to WW. Fear that poor adherence could lead to missed progression and concerns about the medico-legal issue of not doing enough were cited as barriers to decreasing AS. CONCLUSIONS These findings suggest that in certain situations, AS frequency is reduced or transitioned to WW, yet decisions appear to be inconsistent and there are no significant barriers. These findings could inform further areas to explore when drafting recommendations that consider patients' values and preferences when making decisions about decreasing AS/converting to WW.
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Affiliation(s)
- Lisa M Lowenstein
- Health Services Research, The University of Texas MD Anderson Cancer Center Division of Cancer Prevention and Population Sciences, Houston, Texas, USA
| | - Noah J Choi
- Health Services Research, The University of Texas MD Anderson Cancer Center Division of Cancer Prevention and Population Sciences, Houston, Texas, USA
| | - Karen E Hoffman
- Radiation Oncology, MD Anderson Division of Radiation Oncology, Houston, Texas, USA
| | - Robert J Volk
- Health Services Research, The University of Texas MD Anderson Cancer Center Division of Cancer Prevention and Population Sciences, Houston, Texas, USA
| | - Stacy Loeb
- Urology, Population Health, New York University, New York, New York, USA
- Population Health, New York University, New York City, New York, USA
- Manhattat Veterans Affairs Medical Center, New York City, New York, USA
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10
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Alagbe OA, Westphalen AC, Muglia VF. The role of magnetic resonance imaging in active surveillance of prostate cancer. Radiol Bras 2021; 54:246-253. [PMID: 34393292 PMCID: PMC8354198 DOI: 10.1590/0100-3984.2020.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/24/2020] [Indexed: 11/22/2022] Open
Abstract
Active surveillance (AS) is an important strategy to avoid overtreatment of prostate cancer (PCa) and has become the standard of care for low-risk patients. The role of magnetic resonance imaging (MRI) in AS has expanded due to its ability to risk stratify patients with suspected or known PCa, and MRI has become an integral part of the AS protocols at various institutions. A negative pre-biopsy MRI result is associated with a very high negative predictive value for a Gleason score ≥ 3+4. A positive MRI result in men who are otherwise eligible for AS has been shown to be associated with the presence of high-grade PCa and therefore with ineligibility. In addition, MRI can be used to guide and determine the timing of per-protocol biopsy during AS. However, there are several MRI-related issues that remain unresolved, including the lack of a consensus and guidelines; concerns about gadolinium deposition in various tissues; and increased demand for higher efficiency and productivity. Similarly, the need for the combined use of targeted and systematic sampling is still a matter of debate when lesions are visible on MRI. Here, we review the current AS guidelines, as well as the accepted roles of MRI in patient selection and monitoring, the potential uses of MRI that are still in question, and the limitations of the method.
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Affiliation(s)
- Olayemi Atinuke Alagbe
- Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Valdair Francisco Muglia
- Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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11
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Merriel SWD, Moon D, Dundee P, Corcoran N, Carroll P, Partin A, Smith JA, Hamdy F, Moore C, Ost P, Costello T. A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance. BMC Urol 2021; 21:18. [PMID: 33541309 PMCID: PMC7863517 DOI: 10.1186/s12894-021-00789-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Samuel W D Merriel
- College of Medicine and Health, University of Exeter, 1.18 College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Daniel Moon
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Phil Dundee
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Niall Corcoran
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Carroll
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Alan Partin
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, USA
| | - Joseph A Smith
- Department of Urologic Surgery, Vanderbilt University, Nashville, USA
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Caroline Moore
- Division of Surgery and Interventional Medicine, University College London, London, UK
| | - Piet Ost
- Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Tony Costello
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
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12
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Haberal HB, Artykov M, Hazir B, Citamak B, Altan M, Yazici S, Akdogan B, Ozen H. Predictors of ISUP score upgrade in patients with low-risk prostate cancer. TUMORI JOURNAL 2020; 107:254-260. [PMID: 32727308 DOI: 10.1177/0300891620943953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The literature contains few studies that focus on the relationship between International Society of Urological Pathology (ISUP) score upgrade and complete blood count (CBC) parameters for patients with low-risk prostate cancer and studies achieved inconclusive results. METHODS We retrospectively analyzed our institutional database for patients with prostate cancer who underwent radical prostatectomy (RP) between 1994 and 2017. In total, we included 633 patients with low-risk prostate cancer in the study. We investigated the effects of clinicopathologic factors on ISUP score upgrade. Moreover, we compared RP pathologic outcomes between the patients with and without ISUP score upgrade. RESULTS The mean age and follow-up periods were 61.09±6.61 years and 41.9±1.8 months, respectively. ISUP score upgrade was observed in 207 patients (32.7%). In multivariate analysis, high prostate-specific antigen (PSA) density and percentage of positive cores were found to be significantly associated with ISUP score upgrade (p = 0.003 and p = 0.003, respectively). The neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and eosinophil-lymphocyte ratio were found to have no effect on ISUP score upgrade (p = 0.856, p = 0.353, p = 0.128, and p = 0.074, respectively). The percentage of tumors, surgical margin positivity, seminal vesicle invasion rate, and extraprostatic extension rate in RP pathology were higher in patients with ISUP score upgrade (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSIONS Approximately one-third of the patients in our series had ISUP score upgrade in RP pathology. PSA density and the percentage of positive cores were found to be the factors significantly associated with ISUP score upgrade. CBC-related factors had no effect on ISUP score upgrade.
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Affiliation(s)
| | - Meylis Artykov
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Berk Hazir
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sertac Yazici
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Haluk Ozen
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
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13
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Le Paih JP, Bladou F, Klein C, Rouget B, Hugo M, Ferrière JM, Bensadoun H, Bernhard JC, Capon G, Robert G. [Predictive factors of active surveillance interruption for prostate cancer after 5years of follow-up]. Prog Urol 2020; 30:463-471. [PMID: 32482513 DOI: 10.1016/j.purol.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND PURPOSE The objective of this work was to identify the risk factors (RFs) of active surveillance (AS) interruption in a prostate cancer (PCa) single-center retrospective cohort of patients. MATERIAL AND METHOD All patients in AS between January 2011 and October 2019 were retrospectively included in a computerized database. The group of patients who had an AS interruption was compared to the one still under AS, in order to identify potential risk factors for the interruption of the surveillance protocol. RESULTS Two hundred and two patients have been included in the AS cohort with a median follow-up of 32months. At the time of analysis, 72 patients (36%) were not under the AS protocol anymore, 118 (58%) were still under AS and 12 (6%) were lost of follow-up. Sixty-six patients (92%) had left SA due to PCa progression, 4 (5%) by personal choice and 2 (3%) switched to watchful waiting. A PSA doubling Time<3years (PSADT<3years) has been identified as the only statistically significant RF for AS interruption, both in the unvaried (P<0.001) and multivariate (OR=5.403, P<0.01) analysis. It was also the only RF of AS interruption in the early analysis in the first three years of AS, in the unvaried analysis (P=0.021) and the multivariate analysis (OR=3.612, P=0.018). CONCLUSION PSADT was the only RF of AS early and late interruption in our study. It represents a major inclusion criterion in AS protocol during the initial assessment. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- J-P Le Paih
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - F Bladou
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - C Klein
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - B Rouget
- Service d'urologie, centre hospitalier de Libourne, 112, rue de la Marne, BP 199, 33505 Libourne cedex, France
| | - M Hugo
- Service de gynécologie-obstétrique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J-M Ferrière
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - H Bensadoun
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J-C Bernhard
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - G Capon
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - G Robert
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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14
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Wajs E, Rughoobur G, Burling K, George A, Flewitt AJ, Gnanapragasam VJ. A novel split mode TFBAR device for quantitative measurements of prostate specific antigen in a small sample of whole blood. NANOSCALE 2020; 12:9647-9652. [PMID: 32319508 DOI: 10.1039/d0nr00416b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Easy monitoring of prostate specific antigen (PSA) directly from blood samples would present a significant improvement as compared to conventional diagnostic methods. In this work, a split mode thin film bulk acoustic resonator (TFBAR) device was employed for the first time for label-free measurements of PSA concentrations in the whole blood and without sample pre-treatment. The surface of the sensor was covalently modified with anti-PSA antibodies and demonstrated a very high sensitivity of 101 kHz mL ng-1 and low limit of detection (LOD) of 0.34 ng mL-1 in model spiked solutions. It has previously been widely believed that significant pre-processing of blood samples would be required for TFBAR biosensors. Importantly, this work demonstrates that this is not the case, and TFBAR technology provides a cost-effective means for point-of-care (POC) diagnostics and monitoring of PSA in hospitals and in doctors' offices. Additionally, the accuracy of the developed biosensor, with respect to a commercial auto analyser (Beckman Coulter Access), was evaluated to analyse clinical samples, giving well-matched results between the two methods, thus showing a practical application in quantitative monitoring of PSA levels in the whole blood with very good signal recovery.
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Affiliation(s)
- Ewelina Wajs
- Electrical Engineering, University of Cambridge, 9 JJ Thomson Avenue, Cambridge, CB3 0FA, UK.
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15
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Magnetic Resonance Imaging for the Detection of High Grade Cancer in the Canary Prostate Active Surveillance Study. J Urol 2020; 204:701-706. [PMID: 32343189 DOI: 10.1097/ju.0000000000001088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We investigated the ability of prostate magnetic resonance imaging to detect Gleason Grade Group 2 or greater cancer in a standardized, multi-institutional active surveillance cohort. MATERIALS AND METHODS We evaluated men enrolled in Canary Prostate Active Surveillance Study with Gleason Grade Group less than 2 and who underwent biopsy within 12 months of multiparametric magnetic resonance imaging. Our primary outcome was biopsy reclassification to Gleason Grade Group 2 or greater. We evaluated the performance of magnetic resonance imaging PI-RADS® score and clinical factors. Multivariable logistic regression models were fit with magnetic resonance imaging and clinical factors and used to perform receiver operating curve analyses. RESULTS There were 361 participants with 395 prostate magnetic resonance imaging studies with a median followup of 4.1 (IQR 2.0-7.6) years. Overall 108 (27%) biopsies showed reclassification. Defining positive magnetic resonance imaging as PI-RADS 3-5, the negative predictive value and positive predictive value for detecting Gleason Grade Group 2 or greater cancer was 83% (95% CI 76-90) and 31% (95% CI 26-37), respectively. PI-RADS was significantly associated with reclassification (PI-RADS 5 vs 1 and 2 OR 2.71, 95% CI 1.21-6.17, p=0.016) in a multivariable model but did not improve upon a model with only clinical factors (AUC 0.768 vs 0.762). In 194 fusion biopsies higher grade cancer was found in targeted cores in 21 (11%) instances, while 25 (13%) had higher grade cancer in the systematic cores. CONCLUSIONS This study adds the largest cohort data to the body of literature for magnetic resonance imaging in active surveillance, recommending systematic biopsy in patients with negative magnetic resonance imaging and the inclusion of systematic biopsy in patients with positive magnetic resonance imaging.
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16
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Connor MJ, Gorin MA, Ahmed HU, Nigam R. Focal therapy for localized prostate cancer in the era of routine multi-parametric MRI. Prostate Cancer Prostatic Dis 2020; 23:232-243. [PMID: 32051551 DOI: 10.1038/s41391-020-0206-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prostate cancer focal therapy aims to minimize the side-effects of whole gland treatments, such as radical prostatectomy and radiotherapy without compromising oncological efficacy. However, concerns exist regarding the multifocal nature of prostate cancer and the lack of long-term oncological data for this form of treatment. In recent years, the routine adoption of multi-parametric magnetic resonance imaging (mpMRI) of the prostate has improved our ability to select candidates for focal therapy and to accurately deliver this form of prostate cancer treatment. METHODS We performed a review of the literature to provide a summary of the oncological and functional outcomes of men receiving primary prostate focal therapy. Furthermore, we discuss the impact of the routine implementation of mpMRI as part of the initial prostate cancer diagnostic pathway on the selection of candidates and delivery of focal therapy. Finally, we summarize knowledge gaps in the field and highlight active clinical trials in this arena. RESULTS Primary focal therapy involves the application of one of a number of energies that ablate tissue, such as cryotherapy and high intensity focused ultrasound (HIFU). Success is principally dependent on highly accurate patient selection and disease localization underpinned in large part by the routine integration of pre-biopsy mpMRI. Prospective medium-term follow-up data for primary HIFU and cryotherapy for men with intermediate-risk disease have shown acceptable cancer control with low risk of side effects and complications. Additional research is needed to clearly define an appropriate follow-up approach and to guide the management of in- and out-of-field recurrences. Multiple comparative trials with randomization against standard care are currently underway in men with intermediate- and high-risk prostate cancer. CONCLUSION The widespread adoption of prostate mpMRI has led to improved disease localization, enabling the performance of focal therapy as a viable treatment strategy for men with low volume intermediate-risk prostate cancer.
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Affiliation(s)
- M J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK. .,Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK.
| | - M A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
| | - R Nigam
- Royal Surrey NHS Foundation Trust, Guildford, Surrey, GU2 7XX, UK.,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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17
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Prostate cancer treatment choices: the GP's role in shared decision making. Br J Gen Pract 2019; 69:588-589. [PMID: 31780467 DOI: 10.3399/bjgp19x706685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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18
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Lam TBL, MacLennan S, Willemse PPM, Mason MD, Plass K, Shepherd R, Baanders R, Bangma CH, Bjartell A, Bossi A, Briers E, Briganti A, Buddingh KT, Catto JWF, Colecchia M, Cox BW, Cumberbatch MG, Davies J, Davis NF, De Santis M, Dell'Oglio P, Deschamps A, Donaldson JF, Egawa S, Fankhauser CD, Fanti S, Fossati N, Gandaglia G, Gillessen S, Grivas N, Gross T, Grummet JP, Henry AM, Ingels A, Irani J, Lardas M, Liew M, Lin DW, Moris L, Omar MI, Pang KH, Paterson CC, Renard-Penna R, Ribal MJ, Roobol MJ, Rouprêt M, Rouvière O, Sancho Pardo G, Richenberg J, Schoots IG, Sedelaar JPM, Stricker P, Tilki D, Vahr Lauridsen S, van den Bergh RCN, Van den Broeck T, van der Kwast TH, van der Poel HG, van Leenders GJLH, Varma M, Violette PD, Wallis CJD, Wiegel T, Wilkinson K, Zattoni F, N'Dow JMO, Van Poppel H, Cornford P, Mottet N. EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study). Eur Urol 2019; 76:790-813. [PMID: 31587989 DOI: 10.1016/j.eururo.2019.09.020] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023]
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, three phase study was undertaken by the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations, including the following: (1) a systematic review to describe heterogeneity across all domains; (2) a two-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 the consensus were strictly followed. RESULTS AND LIMITATIONS A total of 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 three patients, where consensus was achieved in 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 multiparametric magnetic resonance imaging 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 the 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 (ie, consensus) regarding best practice, which will provide guidance to clinicians and researchers.
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Affiliation(s)
- Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
| | | | | | - Malcolm D Mason
- Division of Cancer and Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - Karin Plass
- EAU Guidelines Office, Arnhem, The Netherlands
| | | | | | - Chris H Bangma
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | | | - Alberto Briganti
- Department of Urology, Scientific Institute and University Vita-Salute San Raffaele Hospital, Milan, Italy
| | | | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Maurizio Colecchia
- Uropathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Brett W Cox
- Department of Radiation Medicine, Zucker School of Medicine, Hempstead, New York, NY, USA
| | | | | | - Niall F Davis
- Department of Urology, Beaumont and Connolly Hospitals, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maria De Santis
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Paolo Dell'Oglio
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; ORSI Academy, Melle, Belgium
| | | | - James F Donaldson
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Shin Egawa
- Asian School of Urology, UAA, Jikei University School of Medicine, Tokyo, Japan
| | | | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Italy
| | - Nicola Fossati
- Department of Urology, Scientific Institute and University Vita-Salute San Raffaele Hospital, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester and The Christie, Manchester, UK; Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, University of Bern, Bern, Switzerland
| | - Nikolaos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tobias Gross
- Department of Urology, University of Bern, Bern, Switzerland
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital, Leeds, UK
| | | | - Jacques Irani
- University Hospital of Bicêtre-Paris Sud-Saclay University, Le Kremlin Bicêtre, France
| | - Michael Lardas
- Department of Reconstructive Urology and Surgical Andrology, Metropolitan General, Athens, Greece
| | - Matthew Liew
- Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Daniel W Lin
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | - Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Catherine C Paterson
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; University of Canberra, School of Nursing, Midwifery and Public Health, Canberra, Australia; Robert Gordon University, School of Nursing and Midwifery, Aberdeen, UK
| | - Raphaële Renard-Penna
- Academic Department of Radiology, Sorbonne Université, GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière-Hôpital Tenon, Paris, France
| | - Maria J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Morgan Rouprêt
- Urology Department, Sorbonne Université, GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - Gemma Sancho Pardo
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jonathan Richenberg
- Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Phillip Stricker
- Department of Urology, St Vincents Hospital and Campus, Sydney, Australia; Garvan Institute of Research, Sydney, Australia
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Philippe D Violette
- Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | | | - Fabio Zattoni
- Urology Unit, Academic Medical Centre Hospital, Udine, Italy
| | - James M O N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital Jean Monnet, St. Etienne, France
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19
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Affiliation(s)
| | - John Davis
- MD Anderson Cancer Center; Houston TX USA
| | - Simon Hughes
- Guy's and St. Thomas NHS Foundation Trust; London UK
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20
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Matheson L, Wilding S, Wagland R, Nayoan J, Rivas C, Downing A, Wright P, Brett J, Kearney T, Cross W, Glaser A, Gavin A, Watson E. The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK-wide mixed methods study. Psychooncology 2019; 28:1567-1575. [PMID: 31132801 DOI: 10.1002/pon.5133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To address concerns over the psychological impact of being on a monitoring pathway following prostate cancer (PCa) diagnosis, this study compared the psychological status of men on active surveillance (AS) or watchful waiting (WW) with men on active treatment (AT) and explored psychological adjustment in men on AS/WW. METHODS Cross-sectional survey of UK men diagnosed with PCa 18 to 42 months previously (n = 16 726, localised disease at diagnosis) and telephone interviews with 24 men on AS/WW. Psychological outcomes were measured using two validated scales (Short Warwick-Edinburgh Mental Well-being Scale [SWEMWBS] and Kessler Psychological Distress Scale). Univariable and multivariable analyses compared outcomes between men on AS/WW and AT. Thematic analysis of interviews was undertaken, informed by a previously developed theory of adjustment to cancer. RESULTS A total of 3986 (23.8%) respondents were on AS/WW. Overall, psychological outcomes were similar or better in men on AS/WW compared with those receiving AT (SWEMWBS: Poor well-being; 12.3% AS/WW vs 13.9% AT, adjusted OR = 0.86, 95% CI, 0.76-0.97; K6: severe psychological distress; 4.6% vs 5.4%, adjusted OR = 0.90, 95% CI, 0.74-1.08). Interviews indicated that most men on AS/WW had adjusted positively. Men with poorer well-being were less able to accept, reframe positively and normalise their diagnosis, described receiving insufficient information and support, and reported a lack of confidence in their health care professionals. CONCLUSIONS Most men on AS/WW cope well psychologically. Men making treatment decisions should be given this information. Psychological health should be assessed to determine suitability for AS/WW, and at monitoring appointments. A clear action plan and support from health care professionals is important.
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Affiliation(s)
- Lauren Matheson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | | | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anna Gavin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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