Prospective Implementation and Early Outcomes of a Risk-stratified Prostate Cancer Active Surveillance Follow-up Protocol.
Active surveillance
Cambridge Prognostic Groups
Favourable intermediate risk
Low risk
Magnetic resonance imaging
Progression
Prostate cancer
Stratified Cancer Surveillance follow-up
Journal
European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
accepted:
15
12
2022
entrez:
6
3
2023
pubmed:
7
3
2023
medline:
7
3
2023
Statut:
epublish
Résumé
Active surveillance (AS) is a major management option for men with early prostate cancer. Current guidelines however advocate identical AS follow-up for all without considering different disease trajectories. We previously proposed a pragmatic three-tier STRATified CANcer Surveillance (STRATCANS) follow-up strategy based on different progression risks from clinic-pathological and imaging features. To report early outcomes from the implementation of the STRATCANS protocol in our centre. Men on AS were enrolled into a prospective stratified follow-up programme. Three tiers of increasing follow-up intensity based on National Institute for Health and Care Excellence (NICE): Cambridge Prognostic Group (CPG) 1 or 2, prostate-specific antigen density, and magnetic resonance imaging (MRI) Likert score at entry. Rates of progression to CPG ≥3, any pathological progression, AS attrition, and patient choice for treatment were assessed. Differences in progression were compared with chi-square statistics. Data from 156 men (median age 67.3 yr) were analysed. Of these, 38.4% had CPG2 disease and 27.5% had grade group 2 disease at diagnosis. The median time on AS was 4 yr (interquartile range 3.2-4.9) and 1.5 yr on STRATCANS. Overall, 135/156 (86.5%) men remained on AS or converted to watchful waiting and 6/156 (3.8%) stopped AS by choice by the end of the evaluation period. Of the 156 patients, 66 (42.3%) were allocated to STRATCANS 1 (least intense follow-up), 61 (39.1%) to STRATCANS 2, and 29 (18.6%) to STRATCANS 3 (highest intensity). By increasing STRATCANS tier, progression rates to CPG ≥3 and any progression events were 0% and 4.6%, 3.4% and 8.6%, and 7.4% and 22.2%, respectively ( A simple risk-tiered AS strategy is possible with early outcomes supporting stratified follow-up intensity. STRATCANS implementation could de-escalate follow-up in men at a low risk of progression while husbanding resources for those who need closer follow-up. We report a practical way to personalise follow-up for men on active surveillance for early prostate cancer. Our method may allow reductions in the follow-up burden for men at a low risk of disease change while maintaining vigilance for those at a higher risk.
Sections du résumé
Background
UNASSIGNED
Active surveillance (AS) is a major management option for men with early prostate cancer. Current guidelines however advocate identical AS follow-up for all without considering different disease trajectories. We previously proposed a pragmatic three-tier STRATified CANcer Surveillance (STRATCANS) follow-up strategy based on different progression risks from clinic-pathological and imaging features.
Objective
UNASSIGNED
To report early outcomes from the implementation of the STRATCANS protocol in our centre.
Design setting and participants
UNASSIGNED
Men on AS were enrolled into a prospective stratified follow-up programme.
Intervention
UNASSIGNED
Three tiers of increasing follow-up intensity based on National Institute for Health and Care Excellence (NICE): Cambridge Prognostic Group (CPG) 1 or 2, prostate-specific antigen density, and magnetic resonance imaging (MRI) Likert score at entry.
Outcome measurements and statistical analysis
UNASSIGNED
Rates of progression to CPG ≥3, any pathological progression, AS attrition, and patient choice for treatment were assessed. Differences in progression were compared with chi-square statistics.
Results and limitations
UNASSIGNED
Data from 156 men (median age 67.3 yr) were analysed. Of these, 38.4% had CPG2 disease and 27.5% had grade group 2 disease at diagnosis. The median time on AS was 4 yr (interquartile range 3.2-4.9) and 1.5 yr on STRATCANS. Overall, 135/156 (86.5%) men remained on AS or converted to watchful waiting and 6/156 (3.8%) stopped AS by choice by the end of the evaluation period. Of the 156 patients, 66 (42.3%) were allocated to STRATCANS 1 (least intense follow-up), 61 (39.1%) to STRATCANS 2, and 29 (18.6%) to STRATCANS 3 (highest intensity). By increasing STRATCANS tier, progression rates to CPG ≥3 and any progression events were 0% and 4.6%, 3.4% and 8.6%, and 7.4% and 22.2%, respectively (
Conclusions
UNASSIGNED
A simple risk-tiered AS strategy is possible with early outcomes supporting stratified follow-up intensity. STRATCANS implementation could de-escalate follow-up in men at a low risk of progression while husbanding resources for those who need closer follow-up.
Patient summary
UNASSIGNED
We report a practical way to personalise follow-up for men on active surveillance for early prostate cancer. Our method may allow reductions in the follow-up burden for men at a low risk of disease change while maintaining vigilance for those at a higher risk.
Identifiants
pubmed: 36874604
doi: 10.1016/j.euros.2022.12.013
pii: S2666-1683(23)00007-1
pmc: PMC9975013
doi:
Types de publication
Journal Article
Langues
eng
Pagination
15-22Informations de copyright
© 2023 The Author(s).
Références
Urol Oncol. 2021 Jul;39(7):432.e1-432.e10
pubmed: 33308973
Semin Oncol Nurs. 2020 Aug;36(4):151045
pubmed: 32703714
Scand J Urol. 2020 Aug;54(4):318-322
pubmed: 32662309
BJU Int. 2021 Jan;127(1):96-107
pubmed: 32531869
Eur Urol. 2022 Apr;81(4):337-346
pubmed: 34980492
Clin Radiol. 2019 Nov;74(11):894.e1-894.e9
pubmed: 31288924
Sci Rep. 2022 Apr 25;12(1):6743
pubmed: 35468921
Scand J Urol. 2013 Oct;47(5):347-55
pubmed: 23883427
Urology. 2018 Oct;120:96-102
pubmed: 29990573
Prostate Int. 2019 Dec;7(4):139-142
pubmed: 31970138
Prostate. 2022 May;82(7):876-879
pubmed: 35254666
Biometrics. 2019 Mar;75(1):153-162
pubmed: 30039528
Urology. 2021 Sep;155:96-100
pubmed: 34087311
BMJ Open. 2019 Aug 22;9(8):e027860
pubmed: 31444180
Health Technol Assess. 2013 May;17(20):vii-xix, 1-281
pubmed: 23697373
AJR Am J Roentgenol. 2017 Jan;208(1):131-139
pubmed: 27726415
J Clin Oncol. 2016 Jun 20;34(18):2182-90
pubmed: 26884580
BMC Med. 2018 Feb 28;16(1):31
pubmed: 29490658
Eur Radiol. 2022 Jan;32(1):680-689
pubmed: 34255161
BJU Int. 2019 Mar;123(3):429-438
pubmed: 30113755
Eur Radiol. 2021 May;31(5):2696-2705
pubmed: 33196886
Eur Urol Oncol. 2022 Dec;5(6):651-658
pubmed: 35437217
Br J Radiol. 2020 Apr;93(1108):20190929
pubmed: 31971823
Clin Genitourin Cancer. 2022 Jun;20(3):e244-e252
pubmed: 35216924
Cancer. 2018 Feb 15;124(4):698-705
pubmed: 29131319
J Natl Compr Canc Netw. 2022 Feb;20(2):151-159
pubmed: 35130495
Eur Urol Open Sci. 2021 Oct 28;34:33-40
pubmed: 34934965
BMC Urol. 2015 Jun 13;15:52
pubmed: 26070313
Eur Urol Open Sci. 2021 Jan 08;24:17-24
pubmed: 34337491
Nat Rev Urol. 2016 Mar;13(3):151-67
pubmed: 26813955
BJU Int. 2018 Jul;122(1):59-65
pubmed: 29438586
Cancers (Basel). 2021 Aug 24;13(17):
pubmed: 34503059
Eur Urol. 2021 Nov;80(5):549-563
pubmed: 34020828
Transl Androl Urol. 2021 Jun;10(6):2828-2831
pubmed: 34295766
BJU Int. 2019 Nov;124(5):758-767
pubmed: 31063245
JAMA Netw Open. 2020 Dec 1;3(12):e2031349
pubmed: 33369661
BJU Int. 2017 Oct;120(4):511-519
pubmed: 28267899
Eur Urol Open Sci. 2022 Jun 14;41:126-133
pubmed: 35813247