Active Surveillance for Prostate Cancer

First, the doctors discuss workup for prostate cancer. They usually obtain an MRI prior to the diagnostic biopsy, but this decision may change in the face of inadequate infrastructure, insurance, and resources. Dr. Siddiqui notes that patients may be distressed when first hearing about their diagnosis, as prostate cancer may be the first serious illness they’ve been diagnosed with. Dr. George recommends discussing the diagnosis in person after pathology is confirmed. Additionally, Dr. Bagrodia uses the WellPrept app to send patients educational material about prostate cancer before they meet with him again.

Next, they discuss the general regimen for active surveillance patients within the first year of diagnosis. Dr. Watts orders an MRI 6 months after the diagnostic biopsy because inflammation from biopsy may be present in the first couple of months. Dr. Minhaj believes that deciding on when to do an MRI scan also depends on the patients’ preferences and personalities. They also discuss different types of biopsies and the use of confirmatory biopsies. The doctors also agree that removing the term “cancer” from grade group 1 prostate cancer could potentially minimize financial toxicity and patient anxiety. For patients who still want to pursue treatment, Dr. Bagrodia believes that urologists should have the refusal to treat patients who push for inappropriate treatment.

Finally, the doctors consider additional factors that may encourage them to consider treatment in low grade prostate cancer, such as a family history of cancer, BRCA mutations, lower urinary tract symptoms, and select molecular biomarkers and pathology characteristics. Dr. George states that the designation of high versus low volume cancer does not matter and should not be a trigger for treatment. Dr. Minhaj notes that for him, younger age is a stronger indication for active surveillance in order to avoid the morbidity of treatment.

Finally, the doctors explain their personal active surveillance regimens and tips for transitioning patients with more serious conditions off of active surveillance once their prostate cancers have been proven to be stable.