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

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Bruinsma, SM 
Bangma, CH 
Carroll, PR 
Leapman, MS 
Rannikko, A 

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.

health care, prostate cancer, quality of life, signs and symptoms
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Nature Reviews Urology
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Nature Publishing Group
This study is linked to a larger project, the Movember Foundation's Global Action Plan on active surveillance for low-risk prostate cancer (GAP3), which is collaboration between institutions, hospitals and research centres in Australia, Canada, France, Finland, Italy, Japan, Netherlands, UK and the USA. The Movember Foundation has invested €1,664,950 in the GAP3 project in order to create the largest centralized database on AS in men with prostate cancer to date, comprising around 40% of all global patient data on AS. The funder did not play any role in the study design, collection, analysis or interpretation of data, or in the drafting of this paper.