Table 1 Active surveillance protocol at Vestfold Hospital Trust.
AS inclusion criteria | Follow-up scheme | AS discontinuation criteria |
|---|---|---|
• Age <75 yearsa • GGG < 3 • PSA ≤ 20 ng/ml • cT <3 • Life expectancy >5 yearsb • Patient preference Low risk CAPRAc 0–2 and PSA < 10 ng/ml and GGG 1 Intermediate risk CAPRAc 3–5 and/or PSA 10–20 ng/ml and/or GGG 2 | Low risk • PSA every 3 months during the first 2 years and every 6 months thereafter • Repeat biopsy 12 months after AS enrolment and every 60 months thereafter (or at increase of PSA level or tumour size) • MRI† after 12, 48 and 60 months Intermediate risk • PSA every 3 months during the first 2 years and every 6 months thereafter • Repeat biopsy 12 and 24 months after AS enrolment, and every 60 months thereafter (or at increase of PSA level or tumour size) • MRI after 12, 24 and 48 months, and every 24 months after that | Triggers for treatment • Histological reclassification (GGG ≥ 3 or increase in number of positive biopsy cores)d • Biochemical reclassification (PSA > 20 ng/ml or PSA doubling time <1 year)e • Clinical reclassification (cT ≥3) • Radiological reclassification (any indication of “progressing appearances” such as increased overall PI-RADS score, new MRI-visible areas, increasing lesion size, EPE or SVI)d • Patient preferencef Transferal to watchful waiting • Age ≥75a • Life expectancy ≤5 yearsb |
