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• W2078703793 abstract "In certain parts of theworld, the ubiquity of prostate-specific antigen (PSA) use in the screening or early detection of prostate cancer (PCa) has led to several downstream phenomena, including the cliches of overdiagnosis and overtreatment of clinically insignificant disease. Coupled with routine incorporation of risk stratification into the management algorithm, many clinicians have adopted the approach of active surveillance (AS), with delayed definitive intervention, if necessary, as a response to this issue [1]. Thisapproachhasbeenembracedbymanypatients, especially those averse to treatment-related complications, notably erectile and urinary dysfunction. The approach has also gained credencewith themedical community,with data showing estimated 10-yr PCa-specific survival with AS for PSA-screened patients (eg, from the European Randomized Study of Screening for Prostate Cancer program) at 97–100% [2,3]. In their recent updatewith close to 1000 patients, Klotz et al showed that just under 30% were initially undergraded and/or understaged, whereby definitive treatment would definitely be warranted [1]. An additional small percentage progressed ingradeduring the follow-up surveillanceperiod. Adoption of AS as part of routine urologic practice, however, has been far from a universal phenomenon. On a global level, there is tremendous variation in the uptake of AS in various geographic regions and countries. A simplistic viewis that inpartsof theworldwhere screeningor early diagnosis based on PSA is less prevalent or nonexistent, the incidence of insignificant PCa found on biopsy can be as low as 5% of all diagnosed PCa. Consequently, substantially fewer patients qualify for AS, and thus uptake of this management approach is miniscule. As a corollary, the level of general health care services, public health-related education and awareness, and availability of urologic specialty care all have a significant impact on whether AS is even feasible. Another requisite forAS is the availabilityof infrastructure for proper diagnostics, including qualifiedhistopathologistswho can competently assign risk levels based on biopsy specimens, and reliable biochemical and imaging diagnostic facilities, since regular follow-up PSA tests and subsequent serial biopsies are essential formonitoring changes in tumour staging and grading. Absence of these crucial elementswould render AS impractical or even impossible. A survey of European Association of Urology members by Azmietal [4] foundthatanimpressive97%ofurologists stated they‘‘offer’’AStoeligiblepatients, somewithinthecontextofa clinical trial and some adhering to an official AS protocol. The response rate for the survey was only 8%, and there was inherent selection bias from responderswho likelyhavemore interest in and familiarity with the subject than nonresponders. Moreover, listing ‘‘offering AS’’ on a survey does not necessarily imply actual engagement or promotion by a particular practitioner. Nevertheless, AS is generally regarded as prevalent in many European countries. In addition, increasing recognition of the benefits of a coordinated multidisciplinary and multiprofessional approach to PCa management and, more important, emphasis on a shared decision-making approach with patients have given AS healthy endorsements in many practice settings [5]. The British Association of Urological Surgeons Cancer Registry showed that the percentage of eligible patients with low-risk PCaelectingASfortheinitialmanagementapproach increased dramatically from 0% to 39% between 2000 and 2006 [6]. Elsewhere, Australia’s Victorian Prostate Cancer Registry recently showed that the uptake of AS by low-risk patients is 35–40% [7]. A phase III intergroup study led by the National Cancer Institute of Canada of AS randomized against initial radical therapy in patients with favourable risk was disappointingly aborted due to slow accrual. The main reason for E U RO P E AN URO L OG Y 6 8 ( 2 0 1 5 ) 8 1 2 – 8 1 3" @default.
• W2078703793 created "2016-06-24" @default.
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• W2078703793 date "2015-11-01" @default.
• W2078703793 modified "2023-09-26" @default.
• W2078703793 title "A Brief Survey of Active Surveillance" @default.
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• W2078703793 doi "https://doi.org/10.1016/j.eururo.2015.04.005" @default.
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