6th ESOU Meeting Debate: Is the evidence on active surveillance satisfactory?”
Friday, 16 January 2009- Prof. Freddie Hamdy (Oxford, UK) presented his arguments in the first plenary session with interactive voting that tackled the question "Active Surveillance: is the available evidence satisfactory?"
The following key messages were amongst the main points highlighted by Hamdy on the issue of active surveillance:
*Delaying immediate intervention in a large number of screen-detected prostate cancer patients is entirely reasonable and ethical
*Active surveillance should be offered to patients in parallel with active treatment options with pros and cons discussed in detail
*‘Intelligent’ large RCTs should be designed to define safe selection and follow-up criteria, as well as patient perceptions.
*Biomarkers of aggressiveness should be discovered and validated, in conjunction with nomograms and risk calculators using genetic profiling
*Common sense should prevail.
Taking the contrary view, Dr. Eric Klein (Cleveland, USA) conceded that "there is no question that there is over-diagnosis of prostate cancer." But he posed several key questions that active surveillance advocates should closely look into.
"Can biologically indolent tumours be actively identified? The answer is no,” Klein said, adding: "Furthermore, can robust clinical tools that reliably signal the need for intervention developed and applied while the tumour is still curable?"
Klein also pointed out the urologists should examine the question of psychological burden on the patient. "What is the psychological burden of active surveillance?" he asked.
For the interactive voting, moderators Professors Bob Djavan and ESOU Chairman Vincent Ravery presented two clinical cases to the audience to vote on.
Results of the audience vote showed that 52.9% of the audience would prefer active surveillance as compared to 37.5% who chose for radical prostatectomy and 9.6% selecting radiation therapy as preferred therapy.
Hamdy and Klein though both noted that in certain cases where the psychological burden and stress on the patient is high and that the lack of treatment is affecting the patient, the attending physician should then consider options other than active surveillance.