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Title: Active surveillance for prostate cancer: a narrative review of clinical guidelines
Austin Authors: Bruinsma, Sophie M;Bangma, Chris H;Carroll, Peter R;Leapman, Michael S;Rannikko, Antti;Petrides, Neophytos;Weerakoon, Mahesha;Bokhorst, Leonard P;Roobol, Monique;Ehdaie, Behfar;Fahey, Michael;Filson, Christopher;Frydenberg, Mark;Gnanapragasam, Vincent;Kakehi, Yoshiyuki;Kattan, Mike;Klotz, Laurence;Lophatananon, Artitaya;Malouf, David;Moore, Caroline;Muir, Kenneth;Parker, Chris;Pickles, Tom;Sanda, Martin;Steyerberg, Ewout;Trock, Bruce;Valdagni, Riccardo;van der Kwast, Theo;Villers, Arnauld;Wicklin Gillespie, Theresa;Zhang, Liying
Institutional Author: Movember GAP3 consortium
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Department of Urology, Erasmus MC, Rotterdam, Netherlands
Department of Urology, University of California, San Francisco, San Francisco, CA, USA
Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
Urology Research, University College London & University College London Hospitals Trust, London, UK
Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Mar-2016 2016-01-27
Publication information: Nature Reviews Urology 2016; 13: 151-167
Abstract: 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.
DOI: 10.1038/nrurol.2015.313
Journal: Nature Reviews Urology
PubMed URL:
Type: Journal Article
Subjects: Practice Guidelines as Topic
Prostatic Neoplasms
Appears in Collections:Journal articles

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