NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.
Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].
Show detailsCRD summary
This review found insufficient evidence to assess whether active surveillance (defined as surveillance with a curative intent) was an appropriate option for men with localised prostate cancer. The authors’ cautious conclusions reflect the limitations of the evidence base and seem appropriate.
Authors' objectives
To assess the evidence for observational management of prostate cancer versus immediate treatment with curative intent. The review addressed a number of questions; this abstract concentrates on the comparative effectiveness part of the review.
Searching
The authors searched MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) and the Health Technology Assessment Database to August 2011. Search strategies were provided in the full report (see Other Publications of Related Interest). Reference lists of included studies were reviewed and technical experts were consulted. Two previous systematic reviews were used as sources of earlier references. Unpublished data and articles not in English were excluded.
Study selection
Longitudinal multicentre studies that compared observational management with active treatment for men with clinically localised prostate cancer were eligible. Non-randomised studies had to use multivariate or other methods to adjust for possible confounders (including age and tumour stage). Observational management with curative intent was defined as active surveillance. Management with a palliative intent was classed as watchful waiting. Outcomes of interest included prostate cancer mortality, all-cause mortality, morbidity of primary treatment, occurrence of metastatic disease, quality of life and costs. Included studies compared watchful waiting with immediate treatment using radical prostatectomy or radiotherapy. Various definitions of watchful waiting were used. Included randomised trials were mostly conducted before prostate-specific antigen screening came into use.
Five reviewers were involved in study selection. Where there was doubt about study eligibility, full-text articles were screened by at least two reviewers; disagreements were resolved by consensus.
Assessment of study quality
Predefined criteria (referenced but not reported in the paper) were used to grade study quality as good, fair or poor.
Quality assessment was performed by one reviewer and confirmed by at least one other; disagreements were resolved by consensus.
Data extraction
Data were extracted by one reviewer and quantitative data were checked by another.
Methods of synthesis
A narrative synthesis was presented. Overall strength of evidence to assess comparative effectiveness of active surveillance versus immediate treatment was rated (high, moderate, low or insufficient) by consensus.
Results of the review
No studies were found that directly compared active surveillance with immediate treatment.
Watchful waiting versus radical prostatectomy: Studies included in previous reviews plus one randomised trial and 12 cohort studies (three prospective and nine retrospective) were included. In total two randomised trials reported long-term follow-up. The larger trial reported a statistically significant survival benefit with prostatectomy. Results of non-randomised studies generally supported the superior effectiveness of prostatectomy. Quality of life results (reported in one randomised and four non-randomised studies) varied according to the domain measured.
Watchful waiting versus radiotherapy: Studies included in previous reviews plus one randomised trial and seven cohort studies were included. The randomised trial found no significant differences in quality of life at 10 years but did not report on mortality. Observational studies generally found lower mortality in men treated with radiotherapy. Quality of life results varied across domains.
Authors' conclusions
There was insufficient evidence to assess whether active surveillance was an appropriate option for men with localised prostate cancer.
CRD commentary
The review question and inclusion criteria were clear. The review focused on active surveillance (as defined by the authors) and also included evidence on other surveillance strategies (defined as watchful waiting by the authors). The authors searched various relevant sources. Limitations placed on the searches mean that relevant unpublished or studies not in English could have been missed. Review methods minimised risks of reviewer errors and bias affecting the review. Study quality was assessed, but limited details were reported in the paper.
A narrative synthesis was appropriate in view of the heterogeneity of the included studies. No studies compared active surveillance with immediate treatment. The authors noted that randomised trials of watchful waiting may not be generalisable to current patient populations.
The authors' cautious conclusions reflect the limitations of the evidence and seem appropriate.
Implications of the review for practice and research
Practice: The authors did not state any implications for practice.
Research: The authors stated that a standard definition that clearly distinguished active surveillance from watchful waiting was required; future clinical studies to compare active surveillance with immediate treatment should have large sample sizes and long-term follow-up.
Funding
Agency for Healthcare Research and Quality, USA.
Bibliographic details
Dahabreh IJ, Chung M, Balk EM, Yu WW, Mathew P, Lau J, Ip S. Active surveillance in men with localized prostate cancer: a systematic review. Annals of Internal Medicine 2012; 156(8): 582-590. [PubMed: 22351515]
Original Paper URL
Other publications of related interest
Ip S, Dahabreh IJ, Chung M, Yu WW, Balk EM, Iovin RC, Mathew P, Luongo T, Dvorak T, Lau J. An evidence review of active surveillance in men with localized prostate cancer. Evidence Report/Technology Assessment no. 204. Rockville, MD, USA: Agency for Healthcare Research and Quality. 2011.
Indexing Status
Subject indexing assigned by NLM
MeSH
Biopsy; Comparative Effectiveness Research; Digital Rectal Examination; Disease Progression; Humans; Male; Neoplasm Grading; Neoplasm Staging; Patient Acceptance of Health Care; Patient Selection; Prostate-Specific Antigen /blood; Prostatic Neoplasms /diagnosis /pathology /therapy; Risk Factors; Watchful Waiting
AccessionNumber
Database entry date
26/04/2012
Record Status
This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.
- CRD summary
- Authors' objectives
- Searching
- Study selection
- Assessment of study quality
- Data extraction
- Methods of synthesis
- Results of the review
- Authors' conclusions
- CRD commentary
- Implications of the review for practice and research
- Funding
- Bibliographic details
- Original Paper URL
- Other publications of related interest
- Indexing Status
- MeSH
- AccessionNumber
- Database entry date
- Record Status
- Review An evidence review of active surveillance in men with localized prostate cancer.[Evid Rep Technol Assess (Full ...]Review An evidence review of active surveillance in men with localized prostate cancer.Ip S, Dahabreh IJ, Chung M, Yu WW, Balk EM, Iovin RC, Mathew P, Luongo T, Dvorak T, Lau J. Evid Rep Technol Assess (Full Rep). 2011 Dec; (204):1-341.
- Review Prostate-Specific Antigen-Based Screening for Prostate Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2018]Review Prostate-Specific Antigen-Based Screening for Prostate Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task ForceFenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. 2018 May
- National Institutes of Health State-of-the-Science Conference: role of active surveillance in the management of men with localized prostate cancer.[Ann Intern Med. 2012]National Institutes of Health State-of-the-Science Conference: role of active surveillance in the management of men with localized prostate cancer.Ganz PA, Barry JM, Burke W, Col NF, Corso PS, Dodson E, Hammond ME, Kogan BA, Lynch CF, Newcomer L, et al. Ann Intern Med. 2012 Apr 17; 156(8):591-5. Epub 2012 Feb 20.
- Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis.[Ann Intern Med. 2013]Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis.Hayes JH, Ollendorf DA, Pearson SD, Barry MJ, Kantoff PW, Lee PA, McMahon PM. Ann Intern Med. 2013 Jun 18; 158(12):853-60.
- The Prostate Cancer Intervention Versus Observation Trial: VA/NCI/AHRQ Cooperative Studies Program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy with watchful waiting for men with clinically localized prostate cancer.[J Natl Cancer Inst Monogr. 2012]The Prostate Cancer Intervention Versus Observation Trial: VA/NCI/AHRQ Cooperative Studies Program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy with watchful waiting for men with clinically localized prostate cancer.Wilt TJ. J Natl Cancer Inst Monogr. 2012 Dec; 2012(45):184-90.
- Active surveillance in men with localized prostate cancer: a systematic review -...Active surveillance in men with localized prostate cancer: a systematic review - Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews
Your browsing activity is empty.
Activity recording is turned off.
See more...