Adherence to Active Surveillance Protocols for Low-risk Prostate Cancer: Results of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance Initiative

Arveen A Kalapara; Jan F M Verbeek; Daan Nieboer; Michael Fahey; Vincent Gnanapragasam; Mieke Van Hemelrijck; Lui Shiong Lee; Chris H Bangma; Ewout W Steyerberg; Tim Harkin; Jozien Helleman; Monique J Roobol; Mark Frydenberg; Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium

doi:10.1016/j.euo.2019.08.014

Adherence to Active Surveillance Protocols for Low-risk Prostate Cancer: Results of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance Initiative

Eur Urol Oncol. 2020 Feb;3(1):80-91. doi: 10.1016/j.euo.2019.08.014. Epub 2019 Sep 26.

Authors

Collaborators

Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium:
Bruce Trock¹⁰, Behfar Ehdaie¹¹, Peter Carroll¹², Christopher Filson¹³, Jeri Kim¹⁴, Christopher Logothetis¹⁴, Todd Morgan¹⁵, Laurence Klotz¹⁶, Tom Pickles¹⁷, Eric Hyndman¹⁸, Caroline M Moore¹⁹, Vincent Gnanapragasam²⁰, Mieke Van Hemelrijck²¹, Prokar Dasgupta²², Chris Bangma²³, Monique Roobol²⁴, Arnauld Villers²⁴, Antti Rannikko²⁵, Riccardo Valdagni²⁶, Antoinette Perry²⁷, Jonas Hugosson²⁸, Jose Rubio-Briones²⁹, Anders Bjartell³⁰, Lukas Hefermehl³¹, Lee Lui Shiong³², Mark Frydenberg³³, Yoshiyuki Kakehi³⁴, Byung Ha Chung³⁵, Theo van der Kwast³⁶, Henk Obbink³⁷, Wim van der Linden³⁷, Tim Hulsen³⁷, Cees de Jonge³⁷, Mike Kattan³⁸, Ji Xinge³⁸, Kenneth Muir³⁹, Artitaya Lophatananon³⁹, Michael Fahey⁴⁰, Ewout Steyerberg⁴¹, Daan Nieboer⁴¹, Liying Zhang⁴², Ewout Steyerberg⁴¹, Daan Nieboer⁴¹, Kerri Beckmann⁴³, Brian Denton⁴⁴, Andrew Hayen⁴⁵, Paul Boutros⁴⁶, Wei Guo⁴⁷, Nicole Benfante⁴⁸, Janet Cowan⁴⁹, Dattatraya Patil⁵⁰, Emily Tolosa⁵¹, Tae-Kyung Kim⁵², Alexandre Mamedov⁴², Vincent LaPointe⁵³, Trafford Crump⁵⁴, Jenna Kimberly-Duffell⁵⁵, Aida Santaolalla⁴³, Daan Nieboer⁴¹, Jonathan Olivier⁵⁶, Tiziana Rancati⁵⁷, Helén Ahlgren⁵⁸, Juanma Mascarós⁵⁹, Annica Löfgren⁶⁰, Kurt Lehmann⁶¹, Catherine Han Lin⁶², Hiromi Hirama⁶³, Kwang Suk Lee⁶⁴, Guido Jenster⁶⁵, Anssi Auvinen⁶⁶, Anders Bjartell⁶⁰, Masoom Haider⁶⁷, Kees van Bochove⁶⁸, Ballentine Carter⁶⁹, Sam Gledhill⁷⁰, Mark Buzza⁷⁰, Chris Bangma⁴¹, Monique Roobol⁴¹, Sophie Bruinsma⁴¹, Jozien Helleman⁴¹

Affiliations

¹ Department of Surgery, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia.
² Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
³ Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
⁴ Epworth HealthCare, Melbourne, Victoria, Australia.
⁵ Academic Urology Group, Department of Surgery and Oncology, University of Cambridge, Cambridge, UK.
⁶ Division of Cancer Studies, Translational Oncology & Urology Research, King's College London, London, UK.
⁷ Singapore General Hospital, Singapore, Singapore.
⁸ Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
⁹ Department of Surgery, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Urology, Monash Health, Victoria, Australia. Electronic address: mark.frydenberg@monash.edu.
¹⁰ Johns Hopkins University -JHU, The James Buchanan Brady Urological Institute, Baltimore, USA.
¹¹ Memorial Sloan Kettering Cancer Center-MSKCC, New York, USA.
¹² University of California San Francisco-UCSF, San Francisco, USA.
¹³ Emory University School of Medicine-EU, Winship Cancer Institute, Atlanta, USA.
¹⁴ MD Anderson Cancer Centre-MDACC, Houston, USA.
¹⁵ University of Michigan and Michigan Urological Surgery Improvement Collaborative-MUSIC, Michigan, USA.
¹⁶ University of Toronto-UOFT, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
¹⁷ University of British Columbia, BC Cancer Agency-UBC, Vancouver, Canada.
¹⁸ University of Calgary-UOFC, Southern Alberta Institute of Urology, Calgary, Canada.
¹⁹ University College London & University College London Hospital Trust-UCL, London, UK.
²⁰ University of Cambridge & Cambridge University Hospitals NHS Foundation Trust-CUHT, Cambridge, UK.
²¹ King's College London, London, UK & Guy's and St Thomas' NHS Foundation Trust-GSTT, London, UK.
²² Guy's and St Thomas' NHS Foundation Trust-GSTT, London, UK.
²³ Erasmus Medical Center-EMC, Rotterdam, The Netherlands/Prostate cancer Research International Active Surveillance (PRIAS) consortium.
²⁴ Lille University Hospital Center-CHU, Lille, France.
²⁵ Helsinki University and Helsinki University Hospital-HUCH, Helsinki, Finland.
²⁶ Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Radiation Oncology 1 and Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori-INT, Milan, Italy.
²⁷ University College Dublin-UCD, Dublin, Ireland.
²⁸ Sahlgrenska University Hospital-SU, Göteborg, Sweden.
²⁹ Instituto Valenciano de Oncología-IVO, Valencia, Spain.
³⁰ Skåne University Hospital-SUS, Malmö, Sweden.
³¹ Kantonsspital Baden-KB, Baden, Switzerland.
³² Singapore General Hospital-SGH, Singapore, Singapore.
³³ Monash Health; Monash University-MEASCAP, Melbourne, Australia.
³⁴ Kagawa University Faculty of Medicine-KU, Kagawa, Japan.
³⁵ Gangnam Severance Hospital, Yonsei University Health System-YUHS, Seoul, Republic of Korea.
³⁶ Princess Margaret Cancer Centre, Toronto, Canada.
³⁷ Royal Philips, Eindhoven, The Netherlands.
³⁸ Cleveland Clinic, Cleveland, Ohio, USA.
³⁹ University of Manchester, Manchester, UK.
⁴⁰ Epworth HealthCare, Melbourne, Australia.
⁴¹ Erasmus Medical Center, Rotterdam, The Netherlands.
⁴² University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁴³ King's College London, London, UK & Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴⁴ University of Michigan, Michigan, USA.
⁴⁵ University of Technology Sydney, Australia.
⁴⁶ Ontario Institute of Cancer Research, Toronto, Ontario, Canada.
⁴⁷ Johns Hopkins University, The James Buchanan Brady Urological Institute, Baltimore, USA.
⁴⁸ Memorial Sloan Kettering Cancer Center, New York, USA.
⁴⁹ University of California San Francisco, San Francisco, USA.
⁵⁰ Emory University School of Medicine, Winship Cancer Institute, Atlanta, USA.
⁵¹ MD Anderson Cancer Centre, Houston, Texas, USA.
⁵² University of Michigan and Michigan Urological Surgery Improvement Collaborative, Ann Arbor, Michigan, USA.
⁵³ University of British Columbia, BC Cancer Agency, Vancouver, Canada.
⁵⁴ University of Calgary, Southern Alberta Institute of Urology, Calgary, Canada.
⁵⁵ University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵⁶ Lille University Hospital Center, Lille, France.
⁵⁷ Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
⁵⁸ Sahlgrenska University Hospital, Göteborg, Sweden.
⁵⁹ Instituto Valenciano de Oncología, Valencia, Spain.
⁶⁰ Skåne University Hospital, Malmö, Sweden.
⁶¹ Kantonsspital Baden, Baden, Switzerland.
⁶² Monash University and Epworth HealthCare, Melbourne, Australia.
⁶³ Kagawa University, Kagawa, Japan.
⁶⁴ Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
⁶⁵ Erasmus MC, Rotterdam, The Netherlands.
⁶⁶ University of Tampere, Tampere, Finland.
⁶⁷ University of Toronto, Toronto, Canada.
⁶⁸ The Hyve B.V. Utrecht, Utrecht, The Netherlands.
⁶⁹ Johns Hopkins University, Baltimore, USA.
⁷⁰ Movember Foundation, Melbourne, Australia.

PMID: 31564531
DOI: 10.1016/j.euo.2019.08.014

Abstract

Background: Active surveillance (AS) enrolment criteria and follow-up schedules for low-risk prostate cancer vary between institutions. However, uncertainty remains about adherence to these protocols.

Objective: To determine adherence to institution-specific AS inclusion criteria and follow-up schedules within the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) initiative.

Design, setting, and participants: We retrospectively assessed the data of 15 101 patients from 25 established AS cohorts worldwide between 2014 and 2016.

Outcome measurements and statistical analysis: Adherence to individual AS inclusion criteria was rated on a five-point Likert scale ranging from poor to excellent. Nonadherence to follow-up schedules was defined as absence of repeat biopsy 1 yr after the scheduled date. Cohorts were pooled into annual and Prostate Cancer Research International: Active Surveillance (PRIAS)-based biopsy schedules, and a generalised linear mixed model was constructed to test for nonadherence.

Results and limitations: Serum prostate-specific antigen (PSA) inclusion criteria were followed in 92%, Gleason score (GS) criteria were followed in 97%, and the number of positive biopsy cores was followed in 94% of men. Both age and tumour stage (T stage) criteria had 99% adherence overall. Pooled nonadherence rates increased over time-8%, 16%, and 34% for annual schedules and 11%, 30%, and 29% for PRIAS-based schedules at 1, 4, and 7 yr, respectively-and did not differ between biopsy schedules. A limitation is that our results do not consider the use of multiparametric magnetic resonance imaging.

Conclusions: In on-going development of evidence-based AS protocols, variable adherence to PSA and GS inclusion criteria should be considered. Repeat biopsy adherence reduces with increased duration of surveillance, independent of biopsy frequency. This emphasises the importance of risk stratification at the commencement of AS.

Patient summary: We studied adherence to active surveillance protocols for prostate cancer worldwide. We found that inclusion criteria were generally followed well, but adherence to repeat biopsy reduced with time. This should be considered when optimising future active surveillance protocols.

Keywords: Active surveillance; Adherence; Prostate cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Epidemiological Monitoring
Humans
Male
Middle Aged
Prostatic Neoplasms / epidemiology*
Prostatic Neoplasms / pathology
Risk Factors

Grants and funding

U01 CA113913/CA/NCI NIH HHS/United States