PURPOSE - To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.
METHODS - The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommendations.
RESULTS - The ASCO Endorsement Panel determined that the recommendations from the Active Surveillance for the Management of Localized Prostate Cancer guideline, published in May 2015, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Active Surveillance for the Management of Localized Prostate Cancer guideline with added qualifying statements. The Cancer Care Ontario recommendation regarding 5-alpha reductase inhibitors was not endorsed by the ASCO panel.
CONCLUSIONS - For most patients with low-risk (Gleason score ≤ 6) localized prostate cancer, active surveillance is the recommended disease management strategy. Factors including younger age, prostate cancer volume, patient preference, and ethnicity should be taken into account when making management decisions. Select patients with low-volume, intermediate-risk (Gleason 3 + 4 = 7) prostate cancer may be offered active surveillance. Active surveillance protocols should include prostate-specific antigen testing, digital rectal examinations, and serial prostate biopsies. Ancillary radiologic and genomic tests are investigational but may have a role in patients with discordant clinical and/or pathologic findings. Patients who are reclassified to a higher-risk category (Gleason score ≥ 7) or who have significant increases in tumor volume on subsequent biopsies should be offered active therapy.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016 Feb 16 [Epub ahead of print]
Ronald C Chen, R Bryan Rumble, D Andrew Loblaw, Antonio Finelli, Behfar Ehdaie, Matthew R Cooperberg, Scott C Morgan, Scott Tyldesley, John J Haluschak, Winston Tan, Stewart Justman, Suneil Jain
Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. , Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.