title: Appropriateness Criteria for Active Surveillance of Prostate Cancer.
abstract: The adoption of active surveillance varies widely across urological communities, which suggests a need for more consistency in the counseling of patients. To address this need we used the RAND/UCLA Appropriateness Method to develop appropriateness criteria and counseling statements for active surveillance.
  
  
  
  Panelists were recruited from MUSIC urology practices. Combinations of parameters thought to influence decision making were used to create and score 160 theoretical clinical scenarios for appropriateness of active surveillance. Recent rates of active surveillance among real patients across the state were assessed using the MUSIC registry.
  
  
  
  Low volume Gleason 6 was deemed highly appropriate for active surveillance whereas high volume Gleason 6 and low volume Gleason 3+4 were deemed appropriate to uncertain. No scenario was deemed inappropriate or highly inappropriate. Prostate specific antigen density, race and life expectancy impacted scores for intermediate and high volume Gleason 6 and low volume Gleason 3+4. The greatest degree of score dispersion (disagreement) occurred in scenarios with long life expectancy, high volume Gleason 6 and low volume Gleason 3+4. Recent rates of active surveillance use among real patients ranged from 0% to 100% at the provider level for low or intermediate biopsy volume Gleason 6, demonstrating a clear opportunity for quality improvement.
  
  
  
  By virtue of this work urologists have the opportunity to present specific recommendations from the panel to their individual patients. Community-wide efforts aimed at increasing rates of active surveillance and reducing practice and physician level variation in the choice of active surveillance vs treatment are warranted.
authors.affiliation: Department of Urology, Wayne State University, Detroit, Michigan. Electronic address: mcher@med.wayne.edu.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Cher
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Apoorv
authors.initials: A
authors.lastname: Dhir
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Auffenberg
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Susan
authors.initials: S
authors.lastname: Linsell
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Comprehensive Urology, Royal Oak, Michigan.
authors.forename: Bradley
authors.initials: B
authors.lastname: Rosenberg
authors.affiliation: Comprehensive Urology, Royal Oak, Michigan.
authors.forename: S Mohammad
authors.initials: SM
authors.lastname: Jafri
authors.affiliation: Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Laurence
authors.initials: L
authors.lastname: Klotz
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Division of Urology, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D011379:Prognosis; D015397:Program Evaluation; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D014572:Urology / Q000458:organization & administration; D057832:Watchful Waiting / Q000458:organization & administration*
chemical_list: D017430:Prostate-Specific Antigen
keywords: counseling; decision making; program evaluation; prostatic neoplasms; watchful waiting