Limits...
Active surveillance of prostate cancer: a questionnaire survey of urologists, clinical oncologists and urology nurse specialists across three cancer networks in the United Kingdom.

Philippou Y, Raja H, Gnanapragasam VJ - BMC Urol (2015)

Bottom Line: In addition, marked variation exists in how patients are followed up with regard to PSA testing intervals and timing of repeat biopsies.Only 40 % undertake a repeat biopsy at 12 months.Tumour upgrading on repeat biopsy, an increase in tumour volume or percentage of core biopsies involved would prompt a recommendation for treatment amongst most survey respondents.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Basildon & Thurrock University Hospital, Essex, SS16 5NL, UK. yp227@doctors.org.uk.

ABSTRACT

Background: Active surveillance is considered a mainstream strategy in the management of patients with low-risk prostate cancer. A mission-critical step in implementing a robust active surveillance program and plan its resource and service requirements, is to gauge its current practice across the United Kingdom. Furthermore it is imperative to determine the existing practices in the context of the recommendations suggested by the recent National Institute for Health and Clinical Excellence guidance on active surveillance of prostate cancer.

Methods: An internet questionnaire was circulated to urologists, clinical oncologists and urology nurse specialists across three geographically distinct cancer networks. Twenty five questions across four domains were assessed. (i) hospital resources (staff and clinical areas) utilised for active surveillance (ii) enrolment criteria (iii) follow up (iv) criteria that trigger conversion to active treatment.

Results: We received 35 responses, 20 of which were from urologists. The survey data suggests that there is marked heterogeneity in enrolment criteria with patients having features of intermediate-risk prostate cancer often recruited into Active Surveillance programs. Only 60 % of our respondents use multiparametric MRI routinely to assess patient suitability for active surveillance. In addition, marked variation exists in how patients are followed up with regard to PSA testing intervals and timing of repeat biopsies. Only 40 % undertake a repeat biopsy at 12 months. Tumour upgrading on repeat biopsy, an increase in tumour volume or percentage of core biopsies involved would prompt a recommendation for treatment amongst most survey respondents. In addition allocation of resources and services for active surveillance is poor. Currently there are no dedicated active surveillance clinics, which are well-structured, -resourced and -supported for regular patient counselling and follow up.

Conclusion: This variability in enrolment criteria and follow up is also demonstrated in international and national series of active surveillance. Resources are not currently in place across the UK to support an active surveillance program and a national discussion and debate to plan resources is much required so that it can become a mainstream therapeutic strategy.

No MeSH data available.


Related in: MedlinePlus

a Respondents views on enrolment criteria for AS from the two geographically distinct cancer networks surveyed. b Respondents views on how they follow up patients on AS from the two geographically distinct cancer networks surveyed
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4465007&req=5

Fig5: a Respondents views on enrolment criteria for AS from the two geographically distinct cancer networks surveyed. b Respondents views on how they follow up patients on AS from the two geographically distinct cancer networks surveyed

Mentions: The same questionnaire was sent out to members of trusts part of two other UK cancer networks. We received a total of 10 responses, five from each cancer network. The findings were very comparable to our own network. There was broad agreement that men under 50 years would not be suitable for AS. In both networks surveyed, there was significant variation in respondent’s views on inclusion criteria for AS (Fig. 5a). Similar to our data, most respondents would include Gleason grade 7 patients in an active surveillance programme but dependent on other clinical characteristics. In one of the two networks studied, a significant number of respondents advocated MRI and transperineal repeat biopsies as part of their assessment of patients suitability for AS. However only a minority of respondents in the other network used any additional biopsy or imaging in evaluating patients suitability. On the question of timing of repeat biopsies there was again variability in the responses (Fig. 5b). The majority advocated re-biopsy at 12 or 18 months after entry onto an AS programme. Finally, we compared triggers to initiate a change in management. Here there was broad consistency in terms of what would initiate a change and included an increase in grade and/or tumour volume. This comparison demonstrated that the lack of dedicated resources and variability in inclusion and follow up in AS is likely to be a universal issue across the NHS.Fig. 5


Active surveillance of prostate cancer: a questionnaire survey of urologists, clinical oncologists and urology nurse specialists across three cancer networks in the United Kingdom.

Philippou Y, Raja H, Gnanapragasam VJ - BMC Urol (2015)

a Respondents views on enrolment criteria for AS from the two geographically distinct cancer networks surveyed. b Respondents views on how they follow up patients on AS from the two geographically distinct cancer networks surveyed
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4465007&req=5

Fig5: a Respondents views on enrolment criteria for AS from the two geographically distinct cancer networks surveyed. b Respondents views on how they follow up patients on AS from the two geographically distinct cancer networks surveyed
Mentions: The same questionnaire was sent out to members of trusts part of two other UK cancer networks. We received a total of 10 responses, five from each cancer network. The findings were very comparable to our own network. There was broad agreement that men under 50 years would not be suitable for AS. In both networks surveyed, there was significant variation in respondent’s views on inclusion criteria for AS (Fig. 5a). Similar to our data, most respondents would include Gleason grade 7 patients in an active surveillance programme but dependent on other clinical characteristics. In one of the two networks studied, a significant number of respondents advocated MRI and transperineal repeat biopsies as part of their assessment of patients suitability for AS. However only a minority of respondents in the other network used any additional biopsy or imaging in evaluating patients suitability. On the question of timing of repeat biopsies there was again variability in the responses (Fig. 5b). The majority advocated re-biopsy at 12 or 18 months after entry onto an AS programme. Finally, we compared triggers to initiate a change in management. Here there was broad consistency in terms of what would initiate a change and included an increase in grade and/or tumour volume. This comparison demonstrated that the lack of dedicated resources and variability in inclusion and follow up in AS is likely to be a universal issue across the NHS.Fig. 5

Bottom Line: In addition, marked variation exists in how patients are followed up with regard to PSA testing intervals and timing of repeat biopsies.Only 40 % undertake a repeat biopsy at 12 months.Tumour upgrading on repeat biopsy, an increase in tumour volume or percentage of core biopsies involved would prompt a recommendation for treatment amongst most survey respondents.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Basildon & Thurrock University Hospital, Essex, SS16 5NL, UK. yp227@doctors.org.uk.

ABSTRACT

Background: Active surveillance is considered a mainstream strategy in the management of patients with low-risk prostate cancer. A mission-critical step in implementing a robust active surveillance program and plan its resource and service requirements, is to gauge its current practice across the United Kingdom. Furthermore it is imperative to determine the existing practices in the context of the recommendations suggested by the recent National Institute for Health and Clinical Excellence guidance on active surveillance of prostate cancer.

Methods: An internet questionnaire was circulated to urologists, clinical oncologists and urology nurse specialists across three geographically distinct cancer networks. Twenty five questions across four domains were assessed. (i) hospital resources (staff and clinical areas) utilised for active surveillance (ii) enrolment criteria (iii) follow up (iv) criteria that trigger conversion to active treatment.

Results: We received 35 responses, 20 of which were from urologists. The survey data suggests that there is marked heterogeneity in enrolment criteria with patients having features of intermediate-risk prostate cancer often recruited into Active Surveillance programs. Only 60 % of our respondents use multiparametric MRI routinely to assess patient suitability for active surveillance. In addition, marked variation exists in how patients are followed up with regard to PSA testing intervals and timing of repeat biopsies. Only 40 % undertake a repeat biopsy at 12 months. Tumour upgrading on repeat biopsy, an increase in tumour volume or percentage of core biopsies involved would prompt a recommendation for treatment amongst most survey respondents. In addition allocation of resources and services for active surveillance is poor. Currently there are no dedicated active surveillance clinics, which are well-structured, -resourced and -supported for regular patient counselling and follow up.

Conclusion: This variability in enrolment criteria and follow up is also demonstrated in international and national series of active surveillance. Resources are not currently in place across the UK to support an active surveillance program and a national discussion and debate to plan resources is much required so that it can become a mainstream therapeutic strategy.

No MeSH data available.


Related in: MedlinePlus