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Within the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) initiative, 25 centers across the globe collaborate to standardize active surveillance (AS) protocols for men with low-risk prostate cancer (PCa). A centralized PCa AS database, comprising data of more than 15 000 patients worldwide, was created. Comparability of the histopathology between the different cohorts was assessed by a centralized pathology review of 445 biopsies from 15 GAP3 centers. Grade group 1 (Gleason score 6) in 85% and grade group >=2 (Gleason score >=7) in 15% showed 89% concordance at review with moderate agreement (kappa = 0.56). Average biopsy core length was similar among the analyzed cohorts. Recently established highly adverse pathologies, including cribriform and/or intraductal carcinoma, were observed in 3.6% of the reviewed biopsies. In conclusion, the centralized pathology review of 445 biopsies revealed comparable histopathology among the 15 GAP3 centers with a low frequency of high-risk features. This enables further data analyses-without correction-toward uniform global AS guidelines for men with low-risk PCa. Patient Summary: Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) initiative combines data from 15 000 men with low-risk prostate cancer (PCa) across the globe to standardize active surveillance protocols. Histopathology review confirmed that the histopathology was consistent with low-risk PCa in most men and comparable between different centers. A centralized pathological review showed consistent biopsy quality and Gleason grading within the global active surveillance Global Action Plan 3 initiative, a prerequisite for future studies toward uniform global guidelines for active surveillance of men with low-risk prostate cancer.Copyright © 2018

Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective(s): Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4-28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0-13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5-2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4-2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for <5 yr, and 149 were lost to follow-up. Cumulative incidence of progression was 27.5% (95% CI: 26.4-28.6%) at 5 yr and 38.2% (95% CI: 36.7-39.9%) at 10 yr. A limitation is that not all centres were included due to limited information on the reason for discontinuation and limited follow-up. Conclusion(s): Our descriptive analyses of current AS practices worldwide showed that 43.6% of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient Summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6% drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS. After about 5 yr, about 56% of men were still

Two active surveillance risk calculators to predict disease reclassification on prostate biopsy are externally validated by the Movember Foundation's Global Action Plan (GAP3) consortium. They proved to be clinically useful and could reduce unnecessary biopsies, but need recalibration to local settings. Background: Men with prostate cancer (PCa) on active surveillance (AS) are followed through regular prostate biopsies, a burdensome and often unnecessary intervention, not without risks. Identifying men with at a low risk of disease reclassification may help reduce the number of biopsies. Objective(s): To assess the external validity of two Canary Prostate Active Surveillance Study Risk Calculators (PASS-RCs), which estimate the probability of reclassification (Gleason grade >=7 with or without >34% of biopsy cores positive for PCa) on a surveillance biopsy, using a mix of months since last biopsy, age, body mass index, prostate-specific antigen, prostate volume, number of prior negative biopsies, and percentage (or ratio) of positive cores on last biopsy. Design, setting, and participants: We used data up to November 2017 from the Movember Foundation's Global Action Plan (GAP3) consortium, a global collaboration between AS studies. Outcome measurements and statistical analysis: External validity of the PASS-RCs for estimating reclassification on biopsy was assessed by calibration, discrimination, and decision curve analyses. Results and limitations: Five validation cohorts (Prostate Cancer Research International: Active Surveillance, Johns Hopkins, Toronto, Memorial Sloan Kettering Cancer Center, and University of California San Francisco), comprising 5105 men on AS, were eligible for analysis. The individual cohorts comprised 429-2416 men, with a median follow-up between 36 and 84 mo, in both community and academic practices mainly from western countries. Abilities of the PASS-RCs to discriminate between men with and without reclassification on biopsy were reasonab

Objectives: The Movember Foundation launched the Global Action Plan Prostate Cancer Active Surveillance (GAP3) initiative to create a global consensus on the selection and monitoring of men with low-risk prostate cancer (PCa) on active surveillance (AS). The aim of this study is to present data on inclusion and follow-up for AS in this unique global AS database. Patients and Methods: Between 2014 and 2016, the database was created by combining patient data from 25 established AS cohorts worldwide (USA, Canada, Australasia, UK and Europe). Data on a total of 15 101 patients were included. Descriptive statistics were used to report patients' clinical and demographic characteristics at the time of PCa diagnosis, clinical follow-up, discontinuation of AS and subsequent treatment. Cumulative incidence curves were used to report discontinuation rates over time. Results: At diagnosis, the median (interquartile range [IQR]) patient age was 65 (60–70) years and the median prostate-specific antigen level was 5.4 (4.0–7.3) ng/mL. Most patients had clinical stage T1 disease (71.8%), a biopsy Gleason score of 6 (88.8%) and one tumour-positive biopsy core (60.3%). Patients on AS had a median follow-up time of 2.2 (1.0–5.0) years. After 5, 10 and 15 years of follow-up, respectively, 58%, 39% and 23% of patients were still on AS. The current version of GAP3 has limited data on magnetic resonance imaging (MRI), quality of life and genomic testing. Conclusions: GAP3 is the largest worldwide collaboration integrating patient data from men with PCa on AS. The results will allow individual patients and clinicians to have greater confidence in the personalized decision to either delay or proceed with active treatment. Longer follow-up and the evaluation of MRI, new genomic markers and patient-related outcomes will result in even more valuable data and eventually in better patient outcomes.

Active surveillance (AS) is broadly described as a management option for men with low-risk prostate cancer, but semantic heterogeneity exists in both the literature and in guidelines. To address this issue, a panel of leading prostate cancer specialists in the field of AS participated in a consensus-forming project using a modified Delphi method to reach international consensus on definitions of terms related to this management option. An iterative three-round sequence of online questionnaires designed to address 61 individual items was completed by each panel member. Consensus was considered to be reached if >=70% of the experts agreed on a definition. To facilitate a common understanding among all experts involved and resolve potential ambiguities, a face-to-face consensus meeting was held between Delphi survey rounds two and three. Convenience sampling was used to construct the panel of experts. In total, 12 experts from Australia, France, Finland, Italy, the Netherlands, Japan, the UK, Canada and the USA participated. By the end of the Delphi process, formal consensus was achieved for 100% (n = 61) of the terms and a glossary was then developed. Agreement between international experts has been reached on relevant terms and subsequent definitions regarding AS for patients with localized prostate cancer. This standard terminology could support multidisciplinary communication, reduce the extent of variations in clinical practice and optimize clinical decision making.Copyright © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.

One of the results of elimate change is an increased amount of precipitation and a rise in rainfall intensity. This can lead to an overlaad on the sewer system or to the ground water level if no sewer system is present, and even to flooding. During rain events part of the rainwater can be intercepted by building surfaces (rainfall interception) . This amount of water is temporarily stared on these surfaces and eventually evaporates into the atmosphere. Since this intercepted water does nat reach the ground, it also does nat contribute to the laad on the sewer system. Especially porous materials on building roots but also in facades can intercept large quantities of water. Rainfall interception by buildings therefore becomes more and more important in hydrological modeling, particularly in urban areas. In this research rainfall interception by building facades is studied. In order to do this measurements as well as simulations are performed. Full-scale measurements are executed on a test facade at Eindhoven University of Technology, the Netherlands. The moisture response (mass change) to wind-driven rain of tour material samples is registered. Furthermore micro-meteorological data are gathered. The ditterenee in rainfall interception by two porous building materials is demonstrated. For the brick with high porosity the rainfall interception yields 100%, while the low porous brick accommodates for a minimum of 76.6% during the measurement period. Due to local saturation at the exterior boundary runaft occurred for the latter type of brick. Besides the tuli-scale experiments an extensive set of Iabaratory measurements is performed. Various moisture-related material properties are determined for the two porous building materials. For the numerical part of this study the finite element code HAMFEM is used. Toga in insight into the moisture response of porous building materials to wind-driven rain, one-dimensional heat and moisture transfer simulations are performed using, One of the results of elimate change is an increased amount of precipitation and a rise in rainfall intensity. This can lead to an overlaad on the sewer system or to the ground water level if no sewer system is present, and even to flooding. During rain events part of the rainwater can be intercepted by building surfaces (rainfall interception) . This amount of water is temporarily stared on these surfaces and eventually evaporates into the atmosphere. Since this intercepted water does nat reach the ground, it also does nat contribute to the laad on the sewer system. Especially porous materials on building roots but also in facades can intercept large quantities of water. Rainfall interception by buildings therefore becomes more and more important in hydrological modeling, particularly in urban areas. In this research rainfall interception by building facades is studied. In order to do this measurements as well as simulations are performed. Full-scale measurements are executed on a test facade at Eindhoven University of Technology, the Netherlands. The moisture response (mass change) to wind-driven rain of tour material samples is registered. Furthermore micro-meteorological data are gathered. The ditterenee in rainfall interception by two porous building materials is demonstrated. For the brick with high porosity the rainfall interception yields 100%, while the low porous brick accommodates for a minimum of 76.6% during the measurement period. Due to local saturation at the exterior boundary runaft occurred for the latter type of brick. Besides the tuli-scale experiments an extensive set of Iabaratory measurements is performed. Various moisture-related material properties are determined for the two porous building materials. For the numerical part of this study the finite element code HAMFEM is used. Toga in insight into the moisture response of porous building materials to wind-driven rain, one-dimensional heat and moisture transfer simulations are performed using

Objective: To analyze the relative risk of reoperation for recurrence using 3 anesthetic alternatives, general anesthesia (GA), regional (spinal-, epidural-) anesthesia (RA), and local anesthesia (LA), and to study time trends for various anesthetic and operative methods, as well as other risk factors regarding reoperation for recurrence. Background: The method of anesthesia used for hernia repair is generally assumed not to affect the long-term outcome. The few studies on the topic have rendered conflicting results. Methods: Data from the Swedish Hernia Register was used. Relative risk was first estimated using univariate analysis for assumed risk variables and then selecting variables with the highest or lowest univariate risk for multivariate analysis. Results: From 1992 through 2001, 59,823 hernia repairs were recorded. Despite the fact that univariate analysis showed a somewhat lower risk for reoperation in the LA group, the multivariate analysis showed that LA was associated with a significantly increased risk for reoperation in primary but not in recurrent hernia repair. The Lichtenstein technique carried a significantly lower reoperation risk than any other method of operation. Conclusions: LA was associated with a higher risk of reoperation for recurrence after primary hernia repair. The use of mesh techniques has increased considerably, and among these the Lichtenstein repair was associated with a significantly lower risk for reoperation than any other repair.