Page 8 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Contents
Executive Summary ................................................................................................................ ES-1
Introduction ................................................................................................................................... 1
Key Questions ........................................................................................................................... 2
Methods .......................................................................................................................................... 5
AHRQ Task Order Officer........................................................................................................ 5
External Expert Input ................................................................................................................ 5
Key Questions ........................................................................................................................... 5
Analytic Framework ................................................................................................................. 5
Literature Searches.................................................................................................................... 6
Study Selection and Eligibility Criteria .................................................................................... 7
Systematic Reviews, Evidence Reports, Economic Evaluations ........................................ 7
Primary Research Studies ................................................................................................... 8
Data Extraction and Summaries.............................................................................................. 11
Primary Research Studies ................................................................................................. 11
Systematic Reviews .......................................................................................................... 12
Quality Assessment ................................................................................................................. 12
Primary Research Studies ................................................................................................. 12
Systematic Reviews .......................................................................................................... 13
Data Synthesis and Presentation ............................................................................................. 13
Summary Tables ..................................................................................................................... 14
Grading the Body of Evidence for Key Question 4 ................................................................ 14
Peer Review and Public Commentary .................................................................................... 15
Results .......................................................................................................................................... 16
Key Question 1. How have the patient population and the natural history of prostate cancer
diagnosed in the United States changed in the last 30 years? ................................................. 17
Trends in Prostate Cancer Incidence................................................................................. 20
Trends in Prostate Cancer Mortality and Survival Rates .................................................. 22
Patient, Tumor, and System-Level Characteristics at Diagnosis ...................................... 24
Trends in Treatment Patterns ............................................................................................ 28
Summary ........................................................................................................................... 28
Key Question 2. How are active surveillance and other observational management strategies
defined? ................................................................................................................................... 29
Protocols With Curative Intent ......................................................................................... 30
Observational Management Strategies With Palliative Intent .......................................... 47
Observational Management Strategies With Unclear Treatment Intent ........................... 58
Summary ........................................................................................................................... 58
Key Question 3. What factors affect the offer of, acceptance of, and adherence to active
surveillance? ........................................................................................................................... 63
Physician Factors (Appendix Tables C3.1–3.3) ............................................................... 65
Clinical Factors ................................................................................................................. 67
Patient Factors ................................................................................................................... 68
Other Factors That Could Affect the Offer of, Acceptance of, or Adherence to AS ........ 70
Summary ........................................................................................................................... 74

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