Page 94 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Gleason score. None of the 13 unique cohorts used the Gleason score as part of followup
protocols for patients who did not receive initial treatments.

Number of cores positive for cancer. None of the 13 unique cohorts used number of cores
positive for cancer as part of followup protocols for patients who did not receive initial
treatments.

Percentage cancer involvement in each core. None of the 13 unique cohorts used number of
cores positive for cancer as part of followup protocols for patients who did not receive initial
treatments.

PSA. Three cohorts formed in the pre-PSA screening era reported that PSA testing became part
of followup protocol after PSA became available. 138,143,147 All six cohorts in the PSA screening
era included regular PSA testing as part of followup protocol. However, rising PSA
concentration alone was not used as a trigger for treatment in five cohorts. 112,144,146,147,149 The
sixth cohort reported that “hormonal manipulation was demanded by the protocol when the PSA
rose to 50 ng/mL.” 148

Imaging. Five cohorts in the pre-PSA screening era included regular bone scan in the followup
protocol. 138-142 The monitoring frequency varied across the cohorts (Figure 6). One cohort also
included regular chest and skeletal radiographs in the followup protocol. 142 Another cohort
reported that computed tomography of the pelvis was conducted infrequently. 138
Three cohorts (4 publications) in the PSA screening era included regular bone scans and chest
radiographs in the followup protocol. 144-146,150 The monitoring frequency varied across the
cohorts (Figure 6). Another cohort reported that all patients underwent “multiple bone scans”
during followup. 148

Behavioral indicators. No behavioral indicator was used explicitly in any of the followup
protocols.

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