Page 38 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

i. Differences in geographical access
2. How are active surveillance and other observational management strategies defined?
a. Common Metrics
i. Age
ii. Gleason
iii. # cores
iv. % cores
v. PSA (velocity, doubling time)
vi. Imaging
vii. Behavioral indicators
b. Followup Protocols
i. Gleason
ii. # cores
iii. % cores
iv. PSA
v. Imaging
vi. Behavioral indicators
3. What factors affect the offer of, acceptance of, and adherence to active surveillance?
a. Physician Factors
i. Primary care
ii. Diagnosing physician
iii. Consultant – second opinion
iv. Clinical factors
b. Patient Factors
i. Family involvement
ii. Personal preferences
iii. Risk perceptions
iv. Family history
v. Social support
c. Delivery System
i. Economic incentives and disincentives
1. Insurance Type (HMO, military, private)
2. Availability of technology
ii. Geographic location
1. Small area variation
2. Regional variation
3. Urban vs. rural
iii. Academic centers vs. private practice
d. Communication Strategies
i. Risk assessment, predictive models
ii. Decision-making tools and aids
4. What are the comparative short- and long-term outcomes of active surveillance versus
immediate treatment with curative intent for localized prostate cancer?
a. Prostate specific and all cause mortality
b. Morbidity of primary treatment decision
c. Incidence of metastatic disease

3