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A narrative overview of active surveillance for clinically localised prostate cancer.

Bates, Anthony S.; Kostakopoulos, Nikolaos; Ayers, Jennifer; Jameson, Molly; Todd, James; Lukha, Ravi; Cymes, Wojciech; Chasapi, Despoina; Brown, Nicole; Bhattacharya, Yagnaseni; Paterson, Catherine; Lam, Thomas B.L.

Authors

Anthony S. Bates

Nikolaos Kostakopoulos

Jennifer Ayers

Molly Jameson

James Todd

Ravi Lukha

Wojciech Cymes

Despoina Chasapi

Nicole Brown

Yagnaseni Bhattacharya

Catherine Paterson

Thomas B.L. Lam



Abstract

Background-Active surveillance (AS) is a strategy employed as an alternative to immediate standard active treatments for patients with low-risk localised prostate cancer (PCa). Active treatments such as radical prostatectomy and radiotherapy are associated with significant adverse effects which impair quality of life. The majority of patients with low-risk PCa undergo a slow and predictable course of cancer growth and do not require immediate curative treatment. AS provides a means to identify and monitor patients with low-risk PCa through regular PSA testing, imaging using MRI scans and regular repeat prostate biopsies. These measures enable the identification of progression, or increase in cancer extent or aggressiveness, which necessitates curative treatment. Alternatively, some patients may choose to leave AS to pursue curative interventions due to anxiety. The main benefit of AS is the avoidance of unnecessary radical treatments for patients at the early stages of the disease, hence avoiding over-treatment, whilst identifying those at risk of progression to be treated actively. The objective of this article is to provide a narrative summary of contemporary practice regarding AS based on a review of the available evidence base and clinical practice guidelines. Elements of discussion include the clinical effectiveness and harms of AS, what AS involves for healthcare professionals, and patient perspectives. The pitfalls and challenges for healthcare professionals are also discussed. Data sources: We consulted international guidelines, collaborative studies and seminal prospective studies on AS in the management of clinically localised PCa. Conclusion: AS is a feasible alternative to radical treatment options for low-risk PCa, primarily as a means of avoiding over-treatment, whilst identifying those who are at risk of disease progression for active treatment. There is emerging data demonstrating the long-term safety of AS as an oncological management strategy. Uncertainties remain regarding variation in definitions, criteria, thresholds and the most effective types of diagnostic interventions pertaining to patient selection, monitoring and reclassification. Efforts have been made to standardise the practice and conduct of AS. As data from high-quality prospective comparative studies mature, the practice of AS will continue to evolve. Implications for Nursing Practice: The practice of AS involves a multi-disciplinary team of healthcare professionals consisting of nurses, urologists, oncologists, pathologists and radiologists. Nurses play a prominent role in managing AS programmes, and are closely involved in patient selection and recruitment, counselling, organising and administering diagnostic interventions including prostate biopsies, and ensuring patients' needs are being met throughout the duration of AS.

Journal Article Type Article
Journal Seminars in oncology nursing
Print ISSN 0749-2081
Publisher Elsevier
Peer Reviewed Peer Reviewed
Article Number 151045
Institution Citation BATES, A.S., KOSTAKOPOULOS, N., AYERS, J., JAMESON, M., TODD, J., LUKHA, R., CYMES, W., CHASAPI, D., BROWN, N., BHATTACHARYA, Y., PATERSON, C. and LAM, T.B.L. [2020]. A narrative overview of active surveillance for clinically localised prostate cancer. Seminars in oncology nursing [online], In Press. Available from: https://doi.org/10.1016/j.soncn.2020.151045
DOI https://doi.org/10.1016/j.soncn.2020.151045
Keywords Active surveillance; Localised low-risk prostate cancer; Narrative review; Guidelines; Heterogeneity of definitions; Thresholds and criteria; Oncology nursing

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