title: Active surveillance for low-risk prostate cancer: diversity of practice across Europe.
abstract: BACKGROUND
  Active surveillance (AS) is a recognised treatment option for low-risk prostate cancer (PCa).
  
  
  OBJECTIVE
  To review AS criteria in terms of patient selection, follow-up and indications for intervention.
  
  
  METHODS
  A total of 2,959 potential participants were identified and invited via email to complete an online survey. Only urologists practising in an EU country were eligible to participate. Statistical analyses were carried out using SPSS version 18.0. The χ (2) test was used to compare responses between those who do and do not follow an AS protocol.
  
  
  RESULTS
  Response rate was 8% (n = 226). Ninety-seven per cent urologists offer AS; 25% (n = 53/215) within a clinical trial and a further 28% (n = 60/215) using an official AS protocol. Gleason score ≤ 3 + 3 = 6 (87 %, n = 173/200) and prostate-specific antigen (PSA) ≤ 10 ng/ml (86%, n = 170/198) are the commonest selection criteria. There was a statistically significant association between having an AS protocol and using PSA as an eligibility criterion (p = 0.03). For urologists not following a protocol, 11% do not consider PSA as an eligibility criterion and 81% consider PSA ≤ 10 ng/ml to decide on AS, compared to 2 and 90%, respectively, who adhere to a protocol. Twenty-four per cent of urologists without a protocol do not re-biopsy in comparison to 11% with a protocol (p = 0.026). Gleason score progression trigger the most intervention (n = 168/192, 87%).
  
  
  CONCLUSIONS
  Urologists not adhering to an AS protocol or participating in a clinical trial appear to apply less rigorous criteria for both eligibility and monitoring in AS.
authors.affiliation: St. Luke's Radiation Oncology Centre, Beaumont Hospital, Dublin, Ireland, aini.azmi@slh.ie.
authors.forename: A
authors.initials: A
authors.lastname: Azmi
authors.forename: R A
authors.initials: RA
authors.lastname: Dillon
authors.forename: S
authors.initials: S
authors.lastname: Borghesi
authors.forename: M
authors.initials: M
authors.lastname: Dunne
authors.forename: R E
authors.initials: RE
authors.lastname: Power
authors.forename: L
authors.initials: L
authors.lastname: Marignol
authors.forename: B D P
authors.initials: BD
authors.lastname: O'Neill
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002985:Clinical Protocols; D051517:Digital Rectal Examination; D018450:Disease Progression; D005060:Europe; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010818:Practice Patterns, Physicians'; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D012307:Risk Factors; D014572:Urology / Q000592:standards; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen