A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance
Abstract Background Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-02-01
|
| Series: | BMC Urology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12894-021-00789-5 |
| _version_ | 1819159757868498944 |
|---|---|
| author | Samuel W. D. Merriel Daniel Moon Phil Dundee Niall Corcoran Peter Carroll Alan Partin Joseph A. Smith Freddie Hamdy Caroline Moore Piet Ost Tony Costello |
| author_facet | Samuel W. D. Merriel Daniel Moon Phil Dundee Niall Corcoran Peter Carroll Alan Partin Joseph A. Smith Freddie Hamdy Caroline Moore Piet Ost Tony Costello |
| author_sort | Samuel W. D. Merriel |
| collection | DOAJ |
| description | Abstract Background Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians from an international panel of prostate cancer experts. Methods A modified Delphi approach was undertaken, utilising two rounds of online questionnaires followed by a face-to-face workshop. Participants indicated their level of agreement with statements relating to patient selection for AS via online questionnaires on a 7-point Likert scale. Factors not achieving agreement were iteratively developed between the two rounds of questionnaires. Draft statements were presented at the face-to-face workshop for discussion and consensus building. Results 12 prostate cancer experts (9 urologists, 2 academics, 1 radiation oncologist) participated in this study from a range of geographical regions (4 USA, 4 Europe, 4 Australia). Complete agreement on statements presented to the participants was 29.4% after Round One and 69.0% after Round Two. Following robust discussions at the face-to-face workshop, agreement was reached on the remaining statements. PSA, PSA density, Multiparametric MRI, and systematic biopsy (with or without targeted biopsy) were identified as minimum diagnostic tests required upon which to select patients to recommend AS as a treatment option for prostate cancer. Patient factors and clinical parameters that identified patients appropriate to potentially receive AS were agreed. Genetic and genomic testing was not recommended for use in clinical decision-making regarding AS. Conclusions The lack of consistency in the practice of AS for men with lower risk prostate cancer between and within countries was reflected in this modified Delphi study. There are, however, areas of common practice and agreement from which clinicians practicing in the current environment can use to inform their clinical practice to achieve the best outcomes for patients. |
| first_indexed | 2024-12-22T16:45:38Z |
| format | Article |
| id | doaj.art-1097860cb2854c00b430d5f8a4cd2edf |
| institution | Directory Open Access Journal |
| issn | 1471-2490 |
| language | English |
| last_indexed | 2024-12-22T16:45:38Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Urology |
| spelling | doaj.art-1097860cb2854c00b430d5f8a4cd2edf2022-12-21T18:19:45ZengBMCBMC Urology1471-24902021-02-012111610.1186/s12894-021-00789-5A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillanceSamuel W. D. Merriel0Daniel Moon1Phil Dundee2Niall Corcoran3Peter Carroll4Alan Partin5Joseph A. Smith6Freddie Hamdy7Caroline Moore8Piet Ost9Tony Costello10College of Medicine and Health, University of ExeterDepartment of Surgery, University of MelbourneDepartment of Urology, Royal Melbourne HospitalDepartment of Urology, Royal Melbourne HospitalDepartment of Urology, University of California San FranciscoJames Buchanan Brady Urological Institute, Johns Hopkins UniversityDepartment of Urologic Surgery, Vanderbilt UniversityNuffield Department of Surgical Sciences, University of OxfordDivision of Surgery and Interventional Medicine, University College LondonRadiation Oncology, Ghent University HospitalDepartment of Surgery, University of MelbourneAbstract Background Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians from an international panel of prostate cancer experts. Methods A modified Delphi approach was undertaken, utilising two rounds of online questionnaires followed by a face-to-face workshop. Participants indicated their level of agreement with statements relating to patient selection for AS via online questionnaires on a 7-point Likert scale. Factors not achieving agreement were iteratively developed between the two rounds of questionnaires. Draft statements were presented at the face-to-face workshop for discussion and consensus building. Results 12 prostate cancer experts (9 urologists, 2 academics, 1 radiation oncologist) participated in this study from a range of geographical regions (4 USA, 4 Europe, 4 Australia). Complete agreement on statements presented to the participants was 29.4% after Round One and 69.0% after Round Two. Following robust discussions at the face-to-face workshop, agreement was reached on the remaining statements. PSA, PSA density, Multiparametric MRI, and systematic biopsy (with or without targeted biopsy) were identified as minimum diagnostic tests required upon which to select patients to recommend AS as a treatment option for prostate cancer. Patient factors and clinical parameters that identified patients appropriate to potentially receive AS were agreed. Genetic and genomic testing was not recommended for use in clinical decision-making regarding AS. Conclusions The lack of consistency in the practice of AS for men with lower risk prostate cancer between and within countries was reflected in this modified Delphi study. There are, however, areas of common practice and agreement from which clinicians practicing in the current environment can use to inform their clinical practice to achieve the best outcomes for patients.https://doi.org/10.1186/s12894-021-00789-5Prostate cancerCancer treatment protocolsPatient selectionActive surveillance |
| spellingShingle | Samuel W. D. Merriel Daniel Moon Phil Dundee Niall Corcoran Peter Carroll Alan Partin Joseph A. Smith Freddie Hamdy Caroline Moore Piet Ost Tony Costello A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance BMC Urology Prostate cancer Cancer treatment protocols Patient selection Active surveillance |
| title | A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance |
| title_full | A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance |
| title_fullStr | A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance |
| title_full_unstemmed | A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance |
| title_short | A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance |
| title_sort | modified delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance |
| topic | Prostate cancer Cancer treatment protocols Patient selection Active surveillance |
| url | https://doi.org/10.1186/s12894-021-00789-5 |
| work_keys_str_mv | AT samuelwdmerriel amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT danielmoon amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT phildundee amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT niallcorcoran amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT petercarroll amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT alanpartin amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT josephasmith amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT freddiehamdy amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT carolinemoore amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT pietost amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT tonycostello amodifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT samuelwdmerriel modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT danielmoon modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT phildundee modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT niallcorcoran modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT petercarroll modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT alanpartin modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT josephasmith modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT freddiehamdy modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT carolinemoore modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT pietost modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance AT tonycostello modifieddelphistudytodevelopapracticalguideforselectingpatientswithprostatecancerforactivesurveillance |