Stratified Cancer Surveillance (StratCanS)
for men being monitored for favourable prognosis prostate cancer
Active surveillance (AS) is a well-established option for men diagnosed with early prostate cancer and is gaining popularity. There is however no consensus on the ideal inclusion and exclusion criteria, how to optimally survey men and what constitutes disease that is unsafe to continue monitoring. The execution of AS therefore varies by individual consultants, teams and hospitals with no agreement on when it should stop nor a tailored approach based on an individual. As a result, all men on AS get the same follow-up regime resulting in a large health resource burden for patients and hospitals. We have developed a novel strategy to classify men by their risk of cancer death (prognosis) and hence define and standardise the point at which AS should stop. Using this we have defined a way to predict which AS men are at the highest risk of progressing to this point. With this knowledge we have devised an innovative stratified AS regime (Stratified Cancer Surveillance: STRATCanS) which we are now implementing into clinical practice. STRATCANS is based on work we have published and presented in 2 cohorts. These are listed below. In essence it stratifies men into 3 different levels of surveillance based on their PSA density, CPG score (see Cambridge Prognostic Group subpage) and MRI findings. Compared to the current status quo where all men get the same regime on AS, we estimate reductions in clinic appointments, MRI and biopsies by up to 50%.
The STRATCANS approach has been recognized for adoption in the East of East of England cancer Alliance 2019 best practice review:
Our current work is looking at refining this and improving the accuracy of stratification as well as external validation in other datasets.
- Gnanapragasam VJ, Barrett T, Thankapannair V, Thurtle D, Rubio-Briones J, Domínguez-Escrig J, Bratt O, Statin P, Muir K, Lophatananon A. Using prognosis to guide inclusion criteria, define standardised endpoints and stratify follow-up in active surveillance for prostate cancer. BJU Int. 2019 May 7. doi:10.1111/bju.14800
- Thurtle D, Barrett T, Thankappan-Nair V, Koo B, Warren A, Kastner C, Saeb-Parsy K, Kimberley-Duffell J, Gnanapragasam VJ. Progression and treatment rates using an active surveillance protocol incorporating image-guided baseline biopsies and multiparametric magnetic resonance imaging monitoring for men with favourable-risk prostate cancer. BJU Int. 2018 Feb 13. doi: 10.1111/bju.14166