TY - JOUR
T1 - Active surveillance for prostate and thyroid cancers
T2 - evolution in clinical paradigms and lessons learned
AU - Lowenstein, Lisa M.
AU - Basourakos, Spyridon P.
AU - Williams, Michelle D.
AU - Troncoso, Patricia
AU - Gregg, Justin R.
AU - Thompson, Timothy C.
AU - Kim, Jeri
N1 - Funding Information:
The work from the authors is supported in part by a Cancer Center Support Grant (CA16672) from the National Cancer Institute and National Institutes of Health.
Publisher Copyright:
© 2018, Springer Nature Limited.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - The adverse effects of overdiagnosis and overtreatment observed in men with clinically insignificant prostate cancers after the introduction of prostate-specific antigen-based screening are now being observed in those with thyroid cancer, owing to the introduction of new imaging technologies. Thus, the evolving paradigm of active surveillance in prostate and thyroid cancers might be valuable in informing the development of future active surveillance protocols. The lessons learned from active surveillance and their implications include the need to minimize the use of broad, population-based screening programmes that do not incorporate patient education and the need for individualized or shared decision-making, which can decrease the extent of overtreatment. Furthermore, from the experience in patients with prostate cancer, we have learned that consensus is required regarding the optimal selection of patients for active surveillance, using more-specific evidence-based methods for stratifying patients by risk. In this Review, we describe the epidemiology, pathology and screening guidelines for the management of patients with prostate and thyroid cancers; the evidence of overdiagnosis and overtreatment; and provide overviews of existing international active surveillance protocols.
AB - The adverse effects of overdiagnosis and overtreatment observed in men with clinically insignificant prostate cancers after the introduction of prostate-specific antigen-based screening are now being observed in those with thyroid cancer, owing to the introduction of new imaging technologies. Thus, the evolving paradigm of active surveillance in prostate and thyroid cancers might be valuable in informing the development of future active surveillance protocols. The lessons learned from active surveillance and their implications include the need to minimize the use of broad, population-based screening programmes that do not incorporate patient education and the need for individualized or shared decision-making, which can decrease the extent of overtreatment. Furthermore, from the experience in patients with prostate cancer, we have learned that consensus is required regarding the optimal selection of patients for active surveillance, using more-specific evidence-based methods for stratifying patients by risk. In this Review, we describe the epidemiology, pathology and screening guidelines for the management of patients with prostate and thyroid cancers; the evidence of overdiagnosis and overtreatment; and provide overviews of existing international active surveillance protocols.
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U2 - 10.1038/s41571-018-0116-x
DO - 10.1038/s41571-018-0116-x
M3 - Review article
C2 - 30413793
AN - SCOPUS:85056335646
SN - 1759-4774
VL - 16
SP - 168
EP - 184
JO - Nature Reviews Clinical Oncology
JF - Nature Reviews Clinical Oncology
IS - 3
ER -