Page 381 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer
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Appendix Table C2.1. Eligibility criteria, follow-up protocols, triggers for intervention and definition of progression in cohorts of active
 surveillance/ watchful waiting/other observational management strategies (continued)

 Center, Country   Eligibility criteria   Followup or monitoring protocol   Triggers for intervention/   Definition of
 [PMID]                          active therapy                   progression
 Enrollment year
 tumor was
 Gleason grade
 4 and <5%
 grade 5.
 Taichung   Men undergoing   After the introduction of serum PSA in 1990, 3-6 monthly PSA   No treatment until there was   Abnormal DRE and/or
 Veterans hospital,   TURP for   and DRE were used to detect the disease progression.    evidence of cancer   progressive
 Taiwan 143    clinically benign   progression.                   elevation of PSA
 [12854876]   hyperplasia of                                      “proved” by
    prostate with                                                 transrectal needle
 1983-1996   stage T1a                                            biopsy, or
 prostate cancer.                                                 appearance of
                                                                  metastatic disease.
 Toronto-SRCC,   Histological   Every 3 mo for the first 2 yr and every 6 mo thereafter   Clinical, histological or PSA   Clinical progression =
 Canada 114    diagnosis of      progression triggered the        at least one of the
 [11395227]   adenocarcinom      offer of treatment based on      following: >2 times
    a of the                     age, extent of disease and       of the product of the
 1995-2002 as a   prostate within   comorbidities. Specific       maximum
 phase II trial   12 mo of       treatment protocol was not       perpendicular
    enrollment; no               reported.                        diameters of the
 2003-ongoing as   previous   Protocol changes in PSA DT          primary lesion as
 an observational   treatment for   assessment, reported in       measured digitally;
 open prospective   prostate     Klotz 2010: 125  For the first 4   symptoms requiring
 cohort   carcinoma;             yr of the study, PSA DT          TURP; development
 clinical stage                  <2y was used as a trigger.       of ureteric
 T1b-T2b N0 M0                   This criterion identified 10%    obstruction;
 (1997 TNM                       of patients as high-risk and     radiological or
 classification);                was considered overly            clinical evidence of
 PSA ≤15ng/ml;                   stringent. In 1999 the cut-      distant metastasis.
 Gleason score                   off was increased to 3 yr.     Histological
 ≤7.                          Protocol changes in PSA DT          progression =
 Protocol changes                calculation, reported in         Gleason score
                                               130
 in inclusion                    Loblaw 2010:     From 1995       upgraded to 8 or
 criteria and                    to 2002 PSA DT was               greater in the
 additional                      calculated by a statistician     rebiopsy of the
 information                     using linear regression of       prostate at 18 mo
 regarding the                   all PSA values after the         post enrollment.
 original criteria,              patient left the clinic and    PSA progression =
 reported in                     the 95% upper bound              when all the
                                 confidence limit of PSA DT       following were




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