A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance

Samuel W.D. Merriel, Daniel Moon, Phil Dundee, Niall Corcoran, Peter Carroll, Alan Partin, Joseph A. Smith, Freddie Hamdy, Caroline Moore, Piet Ost, Tony Costello

Research output: Contribution to journalArticlepeer-review


Background: Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians from an international panel of prostate cancer experts. Methods: A modified Delphi approach was undertaken, utilising two rounds of online questionnaires followed by a face-to-face workshop. Participants indicated their level of agreement with statements relating to patient selection for AS via online questionnaires on a 7-point Likert scale. Factors not achieving agreement were iteratively developed between the two rounds of questionnaires. Draft statements were presented at the face-to-face workshop for discussion and consensus building. Results: 12 prostate cancer experts (9 urologists, 2 academics, 1 radiation oncologist) participated in this study from a range of geographical regions (4 USA, 4 Europe, 4 Australia). Complete agreement on statements presented to the participants was 29.4% after Round One and 69.0% after Round Two. Following robust discussions at the face-to-face workshop, agreement was reached on the remaining statements. PSA, PSA density, Multiparametric MRI, and systematic biopsy (with or without targeted biopsy) were identified as minimum diagnostic tests required upon which to select patients to recommend AS as a treatment option for prostate cancer. Patient factors and clinical parameters that identified patients appropriate to potentially receive AS were agreed. Genetic and genomic testing was not recommended for use in clinical decision-making regarding AS. Conclusions: The lack of consistency in the practice of AS for men with lower risk prostate cancer between and within countries was reflected in this modified Delphi study. There are, however, areas of common practice and agreement from which clinicians practicing in the current environment can use to inform their clinical practice to achieve the best outcomes for patients.

Original languageEnglish (US)
Article number18
JournalBMC Urology
Issue number1
StatePublished - Dec 2021


  • Active surveillance
  • Cancer treatment protocols
  • Patient selection
  • Prostate cancer

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology


Dive into the research topics of 'A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance'. Together they form a unique fingerprint.

Cite this