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Article: Systematic Review of Active Surveillance for Clinically Localised Prostate Cancer to Develop Recommendations Regarding Inclusion of Intermediate-risk Disease, Biopsy Characteristics at Inclusion and Monitoring, and Surveillance Repeat Biopsy Strategy

TitleSystematic Review of Active Surveillance for Clinically Localised Prostate Cancer to Develop Recommendations Regarding Inclusion of Intermediate-risk Disease, Biopsy Characteristics at Inclusion and Monitoring, and Surveillance Repeat Biopsy Strategy
Authors
KeywordsActive surveillance
Clinical practice guidelines and recommendations
Consensus statements
Core involvement
Criteria for inclusion and eligibility
Localised prostate cancer
Monitoring and reclassification
Per-protocol or untriggered repeat biopsies
Positive cores
Systematic review
Issue Date2022
Citation
European Urology, 2022, v. 81, n. 4, p. 337-346 How to Cite?
AbstractContext: There is uncertainty regarding the most appropriate criteria for recruitment, monitoring, and reclassification in active surveillance (AS) protocols for localised prostate cancer (PCa). Objective: To perform a qualitative systematic review (SR) to issue recommendations regarding inclusion of intermediate-risk disease, biopsy characteristics at inclusion and monitoring, and repeat biopsy strategy. Evidence acquisition: A protocol-driven, Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-adhering SR incorporating AS protocols published from January 1990 to October 2020 was performed. The main outcomes were criteria for inclusion of intermediate-risk disease, monitoring, reclassification, and repeat biopsy strategies (per protocol and/or triggered). Clinical effectiveness data were not assessed. Evidence synthesis: Of the 17 011 articles identified, 333 studies incorporating 375 AS protocols, recruiting 264 852 patients, were included. Only a minority of protocols included the use of magnetic resonance imaging (MRI) for recruitment (n = 17), follow-up (n = 47), and reclassification (n = 26). More than 50% of protocols included patients with intermediate or high-risk disease, whilst 44.1% of protocols excluded low-risk patients with more than three positive cores, and 39% of protocols excluded patients with core involvement (CI) >50% per core. Of the protocols, ≥80% mandated a confirmatory transrectal ultrasound biopsy; 72% (n = 189) of protocols mandated per-protocol repeat biopsies, with 20% performing this annually and 25% every 2 yr. Only 27 protocols (10.3%) mandated triggered biopsies, with 74% of these protocols defining progression or changes on MRI as triggers for repeat biopsy. Conclusions: For AS protocols in which the use of MRI is not mandatory or absent, we recommend the following: (1) AS can be considered in patients with low-volume International Society of Urological Pathology (ISUP) grade 2 (three or fewer positive cores and cancer involvement ≤50% CI per core) or another single element of intermediate-risk disease, and patients with ISUP 3 should be excluded; (2) per-protocol confirmatory prostate biopsies should be performed within 2 yr, and per-protocol surveillance repeat biopsies should be performed at least once every 3 yr for the first 10 yr; and (3) for patients with low-volume, low-risk disease at recruitment, if repeat systematic biopsies reveal more than three positive cores or maximum CI >50% per core, they should be monitored closely for evidence of adverse features (eg, upgrading); patients with ISUP 2 disease with increased core positivity and/or CI to similar thresholds should be reclassified. Patient summary: We examined the literature to issue new recommendations on active surveillance (AS) for managing localised prostate cancer. The recommendations include setting criteria for including men with more aggressive disease (intermediate-risk disease), setting thresholds for close monitoring of men with low-risk but more extensive disease, and determining when to perform repeat biopsies (within 2 yr and 3 yearly thereafter).
Persistent Identifierhttp://hdl.handle.net/10722/328823
ISSN
2023 Impact Factor: 25.3
2023 SCImago Journal Rankings: 6.928
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWillemse, Peter Paul M.-
dc.contributor.authorDavis, Niall F.-
dc.contributor.authorGrivas, Nikolaos-
dc.contributor.authorZattoni, Fabio-
dc.contributor.authorLardas, Michael-
dc.contributor.authorBriers, Erik-
dc.contributor.authorCumberbatch, Marcus G.-
dc.contributor.authorDe Santis, Maria-
dc.contributor.authorDell'Oglio, Paolo-
dc.contributor.authorDonaldson, James F.-
dc.contributor.authorFossati, Nicola-
dc.contributor.authorGandaglia, Giorgio-
dc.contributor.authorGillessen, Silke-
dc.contributor.authorGrummet, Jeremy P.-
dc.contributor.authorHenry, Ann M.-
dc.contributor.authorLiew, Matthew-
dc.contributor.authorMacLennan, Steven-
dc.contributor.authorMason, Malcolm D.-
dc.contributor.authorMoris, Lisa-
dc.contributor.authorPlass, Karin-
dc.contributor.authorO'Hanlon, Shane-
dc.contributor.authorOmar, Muhammad Imran-
dc.contributor.authorOprea-Lager, Daniela E.-
dc.contributor.authorPang, Karl H.-
dc.contributor.authorPaterson, Catherine C.-
dc.contributor.authorPloussard, Guillaume-
dc.contributor.authorRouvière, Olivier-
dc.contributor.authorSchoots, Ivo G.-
dc.contributor.authorTilki, Derya-
dc.contributor.authorvan den Bergh, Roderick C.N.-
dc.contributor.authorVan den Broeck, Thomas-
dc.contributor.authorvan der Kwast, Theodorus H.-
dc.contributor.authorvan der Poel, Henk G.-
dc.contributor.authorWiegel, Thomas-
dc.contributor.authorYuan, Cathy Yuhong-
dc.contributor.authorCornford, Philip-
dc.contributor.authorMottet, Nicolas-
dc.contributor.authorLam, Thomas B.L.-
dc.date.accessioned2023-07-22T06:24:19Z-
dc.date.available2023-07-22T06:24:19Z-
dc.date.issued2022-
dc.identifier.citationEuropean Urology, 2022, v. 81, n. 4, p. 337-346-
dc.identifier.issn0302-2838-
dc.identifier.urihttp://hdl.handle.net/10722/328823-
dc.description.abstractContext: There is uncertainty regarding the most appropriate criteria for recruitment, monitoring, and reclassification in active surveillance (AS) protocols for localised prostate cancer (PCa). Objective: To perform a qualitative systematic review (SR) to issue recommendations regarding inclusion of intermediate-risk disease, biopsy characteristics at inclusion and monitoring, and repeat biopsy strategy. Evidence acquisition: A protocol-driven, Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-adhering SR incorporating AS protocols published from January 1990 to October 2020 was performed. The main outcomes were criteria for inclusion of intermediate-risk disease, monitoring, reclassification, and repeat biopsy strategies (per protocol and/or triggered). Clinical effectiveness data were not assessed. Evidence synthesis: Of the 17 011 articles identified, 333 studies incorporating 375 AS protocols, recruiting 264 852 patients, were included. Only a minority of protocols included the use of magnetic resonance imaging (MRI) for recruitment (n = 17), follow-up (n = 47), and reclassification (n = 26). More than 50% of protocols included patients with intermediate or high-risk disease, whilst 44.1% of protocols excluded low-risk patients with more than three positive cores, and 39% of protocols excluded patients with core involvement (CI) >50% per core. Of the protocols, ≥80% mandated a confirmatory transrectal ultrasound biopsy; 72% (n = 189) of protocols mandated per-protocol repeat biopsies, with 20% performing this annually and 25% every 2 yr. Only 27 protocols (10.3%) mandated triggered biopsies, with 74% of these protocols defining progression or changes on MRI as triggers for repeat biopsy. Conclusions: For AS protocols in which the use of MRI is not mandatory or absent, we recommend the following: (1) AS can be considered in patients with low-volume International Society of Urological Pathology (ISUP) grade 2 (three or fewer positive cores and cancer involvement ≤50% CI per core) or another single element of intermediate-risk disease, and patients with ISUP 3 should be excluded; (2) per-protocol confirmatory prostate biopsies should be performed within 2 yr, and per-protocol surveillance repeat biopsies should be performed at least once every 3 yr for the first 10 yr; and (3) for patients with low-volume, low-risk disease at recruitment, if repeat systematic biopsies reveal more than three positive cores or maximum CI >50% per core, they should be monitored closely for evidence of adverse features (eg, upgrading); patients with ISUP 2 disease with increased core positivity and/or CI to similar thresholds should be reclassified. Patient summary: We examined the literature to issue new recommendations on active surveillance (AS) for managing localised prostate cancer. The recommendations include setting criteria for including men with more aggressive disease (intermediate-risk disease), setting thresholds for close monitoring of men with low-risk but more extensive disease, and determining when to perform repeat biopsies (within 2 yr and 3 yearly thereafter).-
dc.languageeng-
dc.relation.ispartofEuropean Urology-
dc.subjectActive surveillance-
dc.subjectClinical practice guidelines and recommendations-
dc.subjectConsensus statements-
dc.subjectCore involvement-
dc.subjectCriteria for inclusion and eligibility-
dc.subjectLocalised prostate cancer-
dc.subjectMonitoring and reclassification-
dc.subjectPer-protocol or untriggered repeat biopsies-
dc.subjectPositive cores-
dc.subjectSystematic review-
dc.titleSystematic Review of Active Surveillance for Clinically Localised Prostate Cancer to Develop Recommendations Regarding Inclusion of Intermediate-risk Disease, Biopsy Characteristics at Inclusion and Monitoring, and Surveillance Repeat Biopsy Strategy-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.eururo.2021.12.007-
dc.identifier.pmid34980492-
dc.identifier.scopuseid_2-s2.0-85122352845-
dc.identifier.volume81-
dc.identifier.issue4-
dc.identifier.spage337-
dc.identifier.epage346-
dc.identifier.eissn1873-7560-
dc.identifier.isiWOS:000834990100012-

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