Active Surveillance
Drs. Hu and Koo briefly review how active surveillance works: scheduled monitoring with, in general, PSA tests every six months, and repeat MRIs and biopsies. They describe which patients should strongly consider this approach, and how a genomic test called Decipher can help confirm that a patient’s cancer is low risk.
Learn more about active surveillance.
Speakers:
Jim C. Hu, MD, MPH, Professor of Urology, Weill Cornell Medicine
Phillip Koo, MD, Chief Medical Officer, Prostate Cancer Foundation
Phillip Koo, MD [00:00:00] So, a patient comes in, they get diagnosed with prostate cancer, usually they see a urologist first and then treatment options are presented to them. Before, we’re not going to get too deep into active surveillance because it’s a very complicated topic. We’ll probably do something separate on active surveillance, but just in general, Dr. Hu, who is most appropriate for active surveillance?
Jim Hu, MD, MPH [00:00:21] Absolutely. So, it’s gonna be, if you look at the guidelines. Guidelines are experts usually internationally that look at level of evidence. And it’s pretty broadly, there’s consensus that for someone with grade group one or formerly known as Gleason 6, that those patients should do active surveillance. And that means monitoring with curative intent in the form of a PSA every six months, repeat MRI and biopsy determined by the initial presentation. There’s increasing use of active surveillance for a grade group two prostate cancer where there’s low percent pattern four. Percent pattern four is the type of cancer that can get outside of the prostate. In general, active surveillance right now is going to be your grade group one patients and your low percent pattern four grade group two prostate cancer patients. It goes back to what Dr. Vapiwala said, which is you’re looking at preferences. Like if someone who values functional outcomes, like they’re more afraid of losing erectile function or urinary incontinence over, for example, the life years that they may gain, which is usually beyond 10 years due to treatment, they’re gonna look at active surveillance. So that’s in general how I think about that in the candidates for active surveillance, and again, a Decipher score can confirm on a molecular level that the patients also have low risk tumors.