Active surveillance for prostate cancer

The request was successful.

Martin Abrams (Prostate Cancer UK)

Dear Ayrshire and Arran NHS Board,

I am writing to you under the Freedom of Information Act to request information about active surveillance for prostate cancer from your Health Board.

We would be grateful for the information at your earliest convenience and within 20 working days.

Please provide your answers by completing the online survey here: https://www.surveymonkey.co.uk/r/AS_pros...

Yours sincerely,

Dr Ali Hansford
Knowledge Manager

Prostate Cancer UK
4th Floor, Counting House
53 Tooley Street
London
SE1 2QN
0203 310 7000

Freedom of Information,

Dear Mr Abrams,

Under section 8 (a) of the Freedom of Information (Scotland) Act 2002 a request requires to be made in permanent form and being capable of being used for subsequent reference.

The use of survey monkey does not meet that criteria.

Please provide a list of the questions that form the survey.

I will be happy to complete the survey-monkey as well but need a copy of the questions for this to be a valid freedom of information request.

Kind regards,

Ann

Ann Catherine Wilson L.L.B.
Freedom of Information Officer
Information Governance
14 Lister Street
University Hospital Crosshouse
Kilmarnock
KA2 0BE
Telephone: 01563 826112
Email: [NHS Ayrshire and Arran request email]

www.nhsaaa.net

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show quoted sections

Martin Abrams (Prostate Cancer UK)

Dear Ann,

In order for you to see all the questions in the request on one page, please find them here: https://docs.google.com/document/d/1lHjY....

If the answers could still be provided online via the survey link here (https://www.surveymonkey.co.uk/r/AS_pros... that would be very much appreciated.

Many thanks
Dr Ali Hansford

Freedom of Information,

Hi,

Sorry but can you please check the URL- seems to be a problem as I keep getting the message:

Sorry, the file you have requested does not exist.

Thanks

Ann

show quoted sections

Martin Abrams (Prostate Cancer UK)

Dear Ann,

Are you able to normally open documents in Google docs? The link is working fine for others so I don't think that is the problem.

Here is the link again:
https://docs.google.com/document/d/1lHjY...

If it doesn't work, then please let me know what email account to send it to (please leave spaces either side of the @ sign otherwise the email address will be hidden).

Many thanks,
Ali

Freedom of Information,

Hi Ali,

Fantastic - can open this link.

Ann

show quoted sections

Freedom of Information,

1 Attachment

Good afternoon,

 

Please accept my apologies for the slight delay in responding to this
request.

 

I have completed the survey monkey as per your request. I have also
provided a hard copy of our response below.

 

Active surveillance protocols

 

Q1.  Does your Trust/Health Board/Health & Social Care Trust have an
active surveillance protocol?

·         Yes – an externally published protocol, e.g. NICE

·         Yes – a local protocol/modified version of an externally
published protocol

Any comments:

[If ‘yes – an externally published protocol’]

A1.  NHS Ayrshire & Arran use external guidance i.e. NICE.  NHS Ayrshire
and Arran now do MRIp prior to every biopsy and pathology is taken with
Artemis targeted biopsies therefore the team is in the process of
establishing specific guidelines.

 

Q2.  Which externally published protocol does the Trust/Health
Board/Health & Social Care Trust use?

·         National Institute for Health and Care Excellence (NICE)
Clinical Guideline 175 protocol for active surveillance (2014):
[1]Available online here

·         Prostate cancer Research International: Active Surveillance
(PRIAS) protocol: [2]Available online here

·         The Royal Marsden protocol

·         The Johns Hopkins programme protocol

·         Other published protocol (please give details) or comments:

A2.  NICE 175 protocol for Active Surveillance (2014)

 

[If ‘yes – a local protocol/modified version of an externally published
protocol’]

 

Q3.  Please outline details of the active surveillance protocol below (or
attach the protocol document when replying to our request email):

[If ‘no’]

A3.  Not applicable.

 

Q4.  Does the Trust/Health Board/Health & Social Care Trust have plans to
introduce a protocol?

·         Yes – please provide details below

·         No – please explain why below

Any comments:

A4.  Yes per response to question one, NHS Ayrshire & Arran will be
introducing a more specific guideline to fit with more detailed pre biopsy
imaging and more precision biopsies

 

Inclusion criteria for active surveillance

 

Q5.  Please indicate below which of the following the Trust/Health
Board/Health & Social Care Trust uses, and in what way, as inclusion
criteria for active surveillance.

If any of the following are used according to the published protocol you
follow (if applicable), then you do not have to provide further details.

A5. 

 (yes/no) Details (e.g. used according
to published protocol, type
(if applicable), how result
is used as inclusion
criteria for active
surveillance):
PSA level (ng/ml) Yes PSA is used as initial
marker along with others. It
is then used along with
other markers to monitor
cancer.
PSA density (ng/ml/ml) Yes PSAD not routinely used but
probably becoming more
representative in making
biopsies likely and
significance.
Clinical stage Yes Confirmed at MDT and AS only
appropriate as per NICE
guidance
Number of biopsy cores involved - Yes After MRIp, currently 5
please indicate the type of biopsy guided standard biopsies
used from each side and 5 or 6
targeted biopsies
Gleason score Yes As per NICE guidance
Risk classification: Yes Patients are classified into
risk category. Low risk most
Low-risk = PSA <10ng/ml and Gleason suitable, intermediate risk
score ≤6 and clinical stage T1-T2a are consider for active
surveillance. High risk not
Intermediate-risk = PSA 10-20ng/ml suitable.
or Gleason score 7 or clinical
stage T2b
Imaging - please indicate the type Yes MRIp and bone scan where
of imaging used appropriate
Biomarkers (e.g. Phi, PCA3, 4K) – No Not used
please indicate the biomarker type
Patient characteristic: Age Yes Considered when assessing
for active surveillance.
Essentially it is an overall
assessment of significant of
diagnosis on individual
persons life expectancy and
quality of life.
Patient characteristic: Life Yes Considered when assessing
expectancy for active surveillance.
Essentially it is an overall
assessment of significant of
diagnosis on individual
persons life expectancy and
quality of life.
Patient characteristic: Fitness Yes Considered when assessing
status/comorbidities for active surveillance.
Essentially it is an overall
assessment of significant of
diagnosis on individual
persons life expectancy and
quality of life.
Patient characteristic: Family Yes Considered when assessing
history of prostate cancer for active surveillance.
Essentially it is an overall
assessment of significant of
diagnosis on individual
persons life expectancy and
quality of life.
Patient characteristic: Ethnicity No This is not initially a
concern when considering
treatment options and is
only considered if a patient
raises it
Patient choice/willingness Yes Most essential part –
patient and family must have
full discussion and not just
be willing but have
understanding
Other (please provide details):

 

Active surveillance clinic

 

Q6.  Does the Trust/Health Board/Health & Social Care Trust have a
dedicated active surveillance clinic?

·         Yes

·         No

Any comments:

A6. No, not a dedicated active surveillance clinic. Currently patients
attend general urology clinic for review.

 

Follow up of men on active surveillance

Q7.  Who manages men on active surveillance? If this changes over time,
please provide details in the comments box below.

(Multiple select)

·         Urologist

·         Oncologist

·         CNS

·         GP

·         Other (please specify) or comments:

A7.  Urologist

 

Q8.  Please indicate below which of the following tools the Trust/Health
Board/Health & Social Care Trust uses, and in what way, to follow up men
during active surveillance.

If any of the following are used according to the published protocol you
follow (if applicable), then you do not have to provide further details.

A8.

Details (e.g. used according to published
protocol, type (if applicable), frequency the tool
is used during active surveillance):
PSA Yes PSA per NICE guideline
Multi-parametric Yes MRIp pre biopsy then at 1 year and then clinically
MRI (mpMRI) assessed thereafter
Repeat biopsy Yes See above
Digital Rectal Yes DRE as per NICE guideline but probably less
Examination (DRE) frequent
Support/counselling Yes Patients are initially reviewed after biopsies by
nurse led team prior to choosing active
surveillance. They have support at that time and
ongoing access to nurse led team as required.
Written information also provided.
Fitness/lifestyle Yes General fitness / lifestyle advice at diagnosis.
interventions Nothing else specific
Other (please
provide details):

Triggers for changing management strategy

Q9.  Please indicate below which of the following the Trust/Health
Board/Health & Social Care Trust uses, and in what way, as potential
triggers for a change in management strategy.

If any of the following are used according to the published protocol you
follow (if applicable), then you do not have to provide further details.

A9.  All in the table are considered when deciding upon further treatment.
A major factor is patient choice and is emphasised when making the
decision and should be considered throughout follow up.

Details (e.g. used according to published protocol,
type (if applicable), what finding triggers a change
in management strategy):
PSA kinetics Yes
Multi-parametric Yes
MRI (mpMRI)
Tumour upgrading Yes
on repeat biopsy
% of positive Yes
biopsy cores
Increase in Yes
tumour volume
Patient choice Yes
Other (please
provide
details):

 

Active surveillance database

 

Q10.  Does the Trust/Health Board/Health & Social Care Trust have a
database of men on active surveillance?

·         Yes

·         No

Any comments:

A10. No

Q11.  Would the Trust/Health Board/Health & Social Care Trust be willing,
and have the resources to, submit their active surveillance patients to a
UK database/registry?

·         Yes

·         No

Any comments:

A11 No. 

 

I trust this response is helpful. However, under the Freedom of
Information (Scotland) Act 2002 if you are dissatisfied with our response
you are entitled to request a review. A request for a review must be made
in writing to Mrs Jillian Neilson, Head of Information Governance, NHS
Ayrshire & Arran, 14 Lister Street, University Hospital Crosshouse,
Kilmarnock, KA2 0BB or email [3][email address],
no later than 40 working days from 18 August 2017. You must provide your
name, an address for correspondence, details of your original request and
say why you want a review. If our decision is unchanged following a review
and you remain dissatisfied with this, you then have the right to make a
formal appeal to the Scottish Information Commissioner at
[4]www.itspublicknowledge.info/Appeal

 

Please do not hesitate to contact me should you require any further advice
or assistance.

 

Kind regards,

 

Ann

 

Ann Catherine Wilson L.L.B                    

Freedom of Information Officer

Information Governance

14 Lister Street

University Hospital Crosshouse

Kilmarnock

KA2 0BE

Telephone: 01563 826112

Email: [5][NHS Ayrshire and Arran request email]

 

 [6]www.nhsaaa.net

 

Find us on Facebook at [7]www.facebook.com/nhsaaa and Twitter @nhsaaa

 

We use 12 point Arial in all our correspondence to make it easier for
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