Active Surveillance for Early Prostate Cancer:
Recommended Risk stratified follow-up schedule.

Active surveillance refers to monitoring of early prostate cancer. The aim of active surveillance is to avoid treatment unless the cancer develops to a stage where it may cause harm. In formal comparison studies it has been found to be as good as immediate treatment in terms of survival (the risk of dying of prostate cancer).

In men with Cambridge Prognostic Group (CPG) 1 or CPG2 prostate cancer, active surveillance is a recommended option for managing prostate cancer by the UK National Institute for Health Care Excellence (NICE). To read about the NICE recommendations and what CPG means, please access the East of England Cancer Alliance website and NICE Guidance Information website – links found on this page (references 1-2.)

Visit the NICE Cambridge Prognostic Group website

The Stratified Cancer Surveillance (STRATCANS) programme has been developed to provide a personalised schedule for monitoring as part of active surveillance. The evidence for this webtool and recommendations comes from the Department of Urology, Cambridge University Hospital and University of Cambridge. The references for this work can be accessed below (references 3-5). STRATCANS assumes that men have been counselled using the Cambridge Prognostic Groups and with the Predict Prostate tool.

View a guide on to how to use these for informed decision making and patient counselling (PDF)

STRATCANS tailors the intervals for PSA test, repeat MRI scans and need for repeat biopsies based on the risks of a cancer progressing to a stage where treatment is usually recommended. This is based on the NICE guidelines and defined as reaching a stage of Cambridge Prognostic Group 3 or higher. It also assumes all diagnosis biopsies were using MRI guidance to sample from targets as well as systematic cores and that there is no disease reclassification from a re-biopsy within 1 year of diagnosis. An early repeat (or confirmatory biopsy) is HIGHLY recommended to offer to patients and ensure the disease burden has been well characterised at the start of AS whether or not first biopsies were done using image guidance (see reference 6). This can also reduce the need for further biopsies later in STRATCANS.

For information on how to implement and use STRATCANS in clinical practice please view the STRATCANS implementation toolkit (PDF)

Use of the STATCANS webtool is entirely the responsibility of the health care team involved and assumes full counselling and that all the evidence base has been read and understood. This webtool only recommends one possible follow-up strategy and any final decision is with the clinical team as to intervals, schedules, and suitability. An active surveillance programme will vary from patient to patient, depending on their specific circumstances, prognostic group, and other factors. If you are a patient viewing this page, it may also be dependent on which consultant you are under and you must discuss its use with your nurse or doctor.

References:

1. NICE guidelines - Prostate cancer: diagnosis and management
View Guidelines Online

2. East of England prostate cancer guidelines -
View Guidelines Online

3. 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. BJU Int. 2019 Nov;124(5):758-767. doi: 10.1111/bju.14800.
View Reference Online

4. Thankapannair V, Keates A, Barrett T, Gnanapragasam VJ. Prospective Implementation and Early Outcomes of a Risk-stratified Prostate Cancer Active Surveillance Follow-up Protocol. Eur Urol Open Sci. 2023 Jan 24;49:15-22.
View Reference Online

5. Michael Wang, Jack Vercnocke, Kevin B. Ginsburg, Stephanie Daignault-Newton, Tudor Borza, Alice Semerjian, Vincent J. Gnanapragasam, APPLICATION OF THE STRATCANS CRITERIA TO THE MUSIC AS COHORT: A STEP TOWARDS RISK STRATIFIED ACTIVE SURVEILLANCE, Urologic Oncology: Seminars and Original Investigations, Volume 42, Supplement, 2024, Page S82, https://doi.org/10.1016/j.urolonc.2024.01.230
View Reference Online

6. Gabb H, Gnanapragasam VJ Value of a confirmatory re-biopsy as part of a modern risk stratified cancer surveillance programme for early prostate cancer. BJUI Compass. 2024 In press https://doi.org/10.1002/bco2.406
View Reference Online

Please enter the data to derive the optimal follow-up schedule based on individual prognosis and risks.

STRATCANS Follow Up Calculator

PSA at diagnosis or level at the point surveillance follow-up intensity is changed
*
Grade Group
MRI stage at diagnosis
MRI PIRADS/LIKERT SCORE at diagnosis or if an updated score is given during surveillance
Prostate Volume (mls)
PSA Density
NICE Cambridge Prognostic Group
(* if the patient is on 5 Alpha reductase inhibitors, use the corrected PSA as the guide)
×

Based on the data you have entered:

PSA
MRI stage T
MRI PIRADS/LIKERT Score
Grade Group
CPG
Prostate Volume mls
PSA Density

The suggested active surveillance follow up schedule is:

Stratcans 1

  • PSA test to be repeated every 3-4 months
  • Clinic review every 18 months
  • MRI:
  • PSA threshold for earlier review

Estimated risk of progression to Cambridge Prognostic Group 3 (CPG3) over an average of 3-4 years of surveillance follow up : 0-3 % (See reference 1)*

* These estimates are based on the studies referenced and assume all diagnosis biopsies were using MRI guidance to sample from targets as well as systematic cores and that there is no disease reclassification from a re-biopsy within 1 year of diagnosis. They may therefore not be generalizable with other practices- audit and data collection is advised at individual centres adopting STRATCANS. An early repeat (or confirmatory biopsy) is recommended to offer to patients & ensure the disease burden has been well characterised at the start of AS whether or not first biopsies were done using image guidance.

Stratcans 2

  • PSA test to be repeated every 3 months
  • Clinic review every 12 months
  • MRI:
  • PSA threshold for earlier review

Estimated risk of progression to Cambridge Prognostic Group 3 (CPG3) over an average of 3-4 years of surveillance follow up : 8-10 % (See reference 1)*

* These estimates are based on the studies referenced and assume all diagnosis biopsies were using MRI guidance to sample from targets as well as systematic cores and that there is no disease reclassification from a re-biopsy within 1 year of diagnosis. They may therefore not be generalizable with other practices- audit and data collection is advised at individual centres adopting STRATCANS. An early repeat (or confirmatory biopsy) is recommended to offer to patients & ensure the disease burden has been well characterised at the start of AS whether or not first biopsies were done using image guidance.

Stratcans 3

  • PSA test to be repeated every 3 months
  • Clinic review every 6 months
  • MRI: Repeat MRI every 12 months
  • PSA threshold for earlier review

Estimated risk of progression to Cambridge Prognostic Group 3 (CPG3) over an average of 3-4 years of surveillance follow up : 14-21 % (See reference 1)*

* These estimates are based on the studies referenced and assume all diagnosis biopsies were using MRI guidance to sample from targets as well as systematic cores and that there is no disease reclassification from a re-biopsy within 1 year of diagnosis. They may therefore not be generalizable with other practices- audit and data collection is advised at individual centres adopting STRATCANS. An early repeat (or confirmatory biopsy) is recommended to offer to patients & ensure the disease burden has been well characterised at the start of AS whether or not first biopsies were done using image guidance.

Unable to calculate the Stratcans schedule from the data provided.

Resources

NICE recommendations for managing early prostate cancer:
The Cancer Alliance “Know Your Options” website

Estimating the personal benefit from treatment versus surveillance:
Predict Prostate website

Video from the East of England Cancer Alliance:
What is active surveillance?

Self-management of PSA results and keeping a record:
TrackMyPSA website

How to add this website as a quick link on your mobile phone screen.

STRATCANS Stratified Cancer Surveillance Calculator

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