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Review
. 2019 Dec;76(6):790-813.
doi: 10.1016/j.eururo.2019.09.020. Epub 2019 Oct 3.

EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study)

Thomas B L Lam  1 , Steven MacLennan  2 , Peter-Paul M Willemse  3 , Malcolm D Mason  4 , Karin Plass  5 , Robert Shepherd  5 , Ruud Baanders  6 , Chris H Bangma  7 , Anders Bjartell  8 , Alberto Bossi  9 , Erik Briers  10 , Alberto Briganti  11 , Karel T Buddingh  12 , James W F Catto  13 , Maurizio Colecchia  14 , Brett W Cox  15 , Marcus G Cumberbatch  16 , Jeff Davies  17 , Niall F Davis  18 , Maria De Santis  19 , Paolo Dell'Oglio  20 , André Deschamps  21 , James F Donaldson  22 , Shin Egawa  23 , Christian D Fankhauser  24 , Stefano Fanti  25 , Nicola Fossati  11 , Giorgio Gandaglia  26 , Silke Gillessen  27 , Nikolaos Grivas  28 , Tobias Gross  29 , Jeremy P Grummet  30 , Ann M Henry  31 , Alexandre Ingels  32 , Jacques Irani  33 , Michael Lardas  34 , Matthew Liew  35 , Daniel W Lin  36 , Lisa Moris  37 , Muhammad Imran Omar  2 , Karl H Pang  16 , Catherine C Paterson  38 , Raphaële Renard-Penna  39 , Maria J Ribal  40 , Monique J Roobol  7 , Morgan Rouprêt  41 , Olivier Rouvière  42 , Gemma Sancho Pardo  43 , Jonathan Richenberg  44 , Ivo G Schoots  45 , J P Michiel Sedelaar  46 , Phillip Stricker  47 , Derya Tilki  48 , Susanne Vahr Lauridsen  49 , Roderick C N van den Bergh  50 , Thomas Van den Broeck  51 , Theodorus H van der Kwast  52 , Henk G van der Poel  28 , Geert J L H van Leenders  52 , Murali Varma  53 , Philippe D Violette  54 , Christopher J D Wallis  55 , Thomas Wiegel  56 , Karen Wilkinson  57 , Fabio Zattoni  58 , James M O N'Dow  22 , Hendrik Van Poppel  51 , Philip Cornford  59 , Nicolas Mottet  60
Affiliations
Free article
Review

EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study)

Thomas B L Lam et al. Eur Urol. 2019 Dec.
Free article

Abstract

Background: There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised.

Objective: To develop consensus statements for all domains of DAT.

Design, setting, and participants: A protocol-driven, three phase study was undertaken by the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations, including the following: (1) a systematic review to describe heterogeneity across all domains; (2) a two-round Delphi survey involving a large, international panel of stakeholders, including healthcare practitioners (HCPs) and patients; and (3) a consensus group meeting attended by stakeholder group representatives. Robust methods regarding what constituted the consensus were strictly followed.

Results and limitations: A total of 109 HCPs and 16 patients completed both survey rounds. Of 129 statements in the survey, consensus was achieved in 66 (51%); the rest of the statements were discussed and voted on in the consensus meeting by 32 HCPs and three patients, where consensus was achieved in additional 27 statements (43%). Overall, 93 statements (72%) achieved consensus in the project. Some uncertainties remained regarding clinically important thresholds for disease extent on biopsy in low-risk disease, and the role of multiparametric magnetic resonance imaging in determining disease stage and aggressiveness as a criterion for inclusion and exclusion.

Conclusions: Consensus statements and the findings are expected to guide and inform routine clinical practice and research, until higher levels of evidence emerge through prospective comparative studies and clinical trials.

Patient summary: We undertook a project aimed at standardising the elements of practice in active surveillance programmes for early localised prostate cancer because currently there is great variation and uncertainty regarding how best to conduct them. The project involved large numbers of healthcare practitioners and patients using a survey and face-to-face meeting, in order to achieve agreement (ie, consensus) regarding best practice, which will provide guidance to clinicians and researchers.

Keywords: Active surveillance and monitoring; Clinical practice guidelines; Consensus group meeting; Consensus statements; Deferred treatment with curative intent; Delphi survey; Eligibility; Follow-up; Localised prostate cancer; Outcome measures; Reclassification.

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