There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised.
To develop consensus statements for all domains of DAT.
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.
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.
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.
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.
European urology. 2019 Oct 03 [Epub ahead of print]
Thomas B L Lam, Steven MacLennan, Peter-Paul M Willemse, Malcolm D Mason, Karin Plass, Robert Shepherd, Ruud Baanders, Chris H Bangma, Anders Bjartell, Alberto Bossi, Erik Briers, Alberto Briganti, Karel T Buddingh, James W F Catto, Maurizio Colecchia, Brett W Cox, Marcus G Cumberbatch, Jeff Davies, Niall F Davis, Maria De Santis, Paolo Dell’Oglio, André Deschamps, James F Donaldson, Shin Egawa, Christian D Fankhauser, Stefano Fanti, Nicola Fossati, Giorgio Gandaglia, Silke Gillessen, Nikolaos Grivas, Tobias Gross, Jeremy P Grummet, Ann M Henry, Alexandre Ingels, Jacques Irani, Michael Lardas, Matthew Liew, Daniel W Lin, Lisa Moris, Muhammad Imran Omar, Karl H Pang, Catherine C Paterson, Raphaële Renard-Penna, Maria J Ribal, Monique J Roobol, Morgan Rouprêt, Olivier Rouvière, Gemma Sancho Pardo, Jonathan Richenberg, Ivo G Schoots, J P Michiel Sedelaar, Phillip Stricker, Derya Tilki, Susanne Vahr Lauridsen, Roderick C N van den Bergh, Thomas Van den Broeck, Theodorus H van der Kwast, Henk G van der Poel, Geert J L H van Leenders, Murali Varma, Philippe D Violette, Christopher J D Wallis, Thomas Wiegel, Karen Wilkinson, Fabio Zattoni, James M O N’Dow, Hendrik Van Poppel, Philip Cornford, Nicolas Mottet
Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. Electronic address: ., Academic Urology Unit, University of Aberdeen, Aberdeen, UK., Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands., Division of Cancer and Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK., EAU Guidelines Office, Arnhem, The Netherlands., Oxford, UK., Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands., Department of Urology, Skåne University Hospital Malmö, Lund University, Lund, Sweden., Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France., Hasselt, Belgium., Department of Urology, Scientific Institute and University Vita-Salute San Raffaele Hospital, Milan, Italy., HagaZiekenhuis, The Hague, The Netherlands., Academic Urology Unit, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., Uropathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy., Department of Radiation Medicine, Zucker School of Medicine, Hempstead, New York, NY, USA., Academic Urology Unit, University of Sheffield, Sheffield, UK., Wales, UK., Department of Urology, Beaumont and Connolly Hospitals, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland., Department of Urology, Charité University Hospital, Berlin, Germany., Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; ORSI Academy, Melle, Belgium., Europa Uomo, Antwerp, Belgium., Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK., Asian School of Urology, UAA, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, University of Zurich, Zurich, Switzerland., Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Italy., Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., 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., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, University of Bern, Bern, Switzerland., Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia., Leeds Cancer Centre, St. James’s University Hospital, Leeds, UK., Department of Urology, Henri Mondor Hospital, Créteil, France., University Hospital of Bicêtre-Paris Sud-Saclay University, Le Kremlin Bicêtre, France., Department of Reconstructive Urology and Surgical Andrology, Metropolitan General, Athens, Greece., Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK., Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., 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., Academic Department of Radiology, Sorbonne Université, GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière-Hôpital Tenon, Paris, France., Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain., Urology Department, Sorbonne Université, GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France., 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., Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK., Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands., Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands., Department of Urology, St Vincents Hospital and Campus, Sydney, Australia; Garvan Institute of Research, Sydney, Australia., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands., Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK., Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada., Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA., Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany., University College London Hospitals, London, UK., Urology Unit, Academic Medical Centre Hospital, Udine, Italy., Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK., Department of Urology, University Hospital Jean Monnet, St. Etienne, France.