Discussion

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  Cite this guideline

Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer. Sydney: Cancer Council Australia. [Version URL: http://wiki.cancer.org.au/australiawiki/index.php?oldid=122840, cited 2017 Nov 22]. Available from: http://wiki.cancer.org.au/australia/Guidelines:PSA_Testing/Watchful_waiting/Discussion.

National Health and Medical Research Council These guidelines (recommendations) in the web-version of this guideline were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 2 November 2015 under section 14A of the National Health and Medical Research Council Act 1992. expand arrow

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In approving the guidelines (recommendations), NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of five years. NHMRC is satisfied that the guidelines (recommendations) are systematically derived, based on the identification and synthesis of the best available scientific evidence, and developed for health professionals practising in an Australian health care setting.

This publication reflects the views of the authors and not necessarily the views of the Australian Government.

Chapter 5 Watchful waiting

Discussion

Unresolved issues

The optimal criteria for choosing watchful waiting have not been identified.

Emerging research may provide more information on the relative contribution of prostate cancer and other illness to cause of death among men undergoing watchful waiting.

Further follow-up data from SPCG-4 (see 5.1 Criteria for selecting watchful waiting) were published after the systematic reviews were completed for this guideline. The investigators reported that 200 of the 347 men in the radical prostatectomy group and 247 of the 348 in the watchful waiting group died during median of 13.4 years follow-up. Death was due to prostate cancer in 99 men assigned to watchful waiting and 63 men assigned to radical prostatectomy (p = 0.001).[1]

There is no high-quality evidence on which to base protocols for watchful waiting.

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Studies currently underway

The SPCG-4[1] and PIVOT[2] studies are currently underway.

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Future research priorities

Important unresolved questions for men with prostate cancer being managed with watchful waiting include:

  • whether there are unmet needs and, if so, their rates and significance
  • the optimal triggers and timing for starting anticancer treatment
  • the optimal components and frequency of follow-up.

References

  1. 1.0 1.1 Bill-Axelson A, Holmberg L, Ruutu M, Garmo H, Stark JR, Busch C, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2011 May 5;364(18):1708-17 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21542742.
  2. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012 Jul 19;367(3):203-13 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22808955.

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