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Speaker 1: Obviously, lots of overlap with what others have said. I guess three questions of interest. One is, I don't know, and we didn't do a PubMed search, but some were questioning what's the financial toxicity of active surveillance? Is there one? And obviously, certain underserved populations may suffer more from that perspective, and maybe that is something worth studying.

The second question is that, at least in our group, the conversations were that if everybody's provided high-quality access, the outcomes of surveillance should not be what I showed in the SEER data. So maybe that is a question worth studying, to see if patients were actually getting an "appropriate diagnosis," fusion biopsy, and so on. Is there a difference in outcomes once they're put on active surveillance?

And then, the third question is, we talked a little bit about cultural differences across different countries and what it means to have a diagnosis of cancer and what it would mean in terms of follow-up care and getting MRIs again and not being lost in follow-up. So it's probably something worth exploring, the same way we have explored these questions for toxicities of treatment. We know that there are quite significant cultural differences with that. Well, what are the cultural differences with the interpretation of, "Do you have cancer or not?"

Speaker 2: Matt, just thinking about the Canary Study, and Dan, maybe you can correct me on this, but I remember one part of it that impressed me was the number of men who have continually sequential biopsies, still have grade group one, and they elect to undergo radical prostatectomy. Potential cure therapy was about the same as the number of men who had reclassification and then had definitive therapy. In other words, the patient really—

Speaker 3: But that's very site-specific. That is not generalizable. We don't have that, Memorial doesn't have that.

Speaker 1: It's less. It's less. But there's a good third.

Speaker 2: But, it's a good number.

Speaker 1: At about a third.

Speaker 2: So, anyway, I was thinking that there's a metric there of patient understanding, and that's one of the challenges, I think.

Speaker 4: There's also the question of how we do surveillance. I mean, there are urologists in California that still don't want to give up anesthesia for biopsies. What better way to drive the patient to radiation therapy than to have them come in and have a badly done anesthesia biopsy every year?

So replacing biopsies with MRI, I mean, we're not where the UK is, but after a confirmatory biopsy, we're using more and more MRI as a replacement for some of the interval biopsies, and deepening and stretching the interval. When guys have grade threes repeatedly, they can wait four, five, six years before the next disease interrogation.

But you're absolutely right, and what we do drives that decision-making.

Speaker 5: We were talking about this earlier, so if we called something ASAP, you guys are going to provide it to the patient in three to six months?

Speaker 4: Oh no, the population is— .

Speaker 5: Not anymore? Okay.

Speaker 3: Lately, my favorite comment of the day, I think, is Sandy says, "Call it a neoplasm" and lead a more ecumenical consideration of clinical, biological, and everything else we can understand about it. It weighs on how we present it.

Speaker 6: I like stage zero myself.

Speaker 3: Stage zero?

Speaker 6: Yeah.

Speaker 3: Power of Velensky or not, it's still a cancer, though. We call it a stage zero cancer...

Speaker 6: A neoplasm?

Speaker 7: If a patient reads neoplasm, they want to understand it, then they'll go look it up and register, and they'll find sense in it.

Speaker 1: No, a neoplasm is a growth. You have benign here.

All right. It is 5:00. We're going to wrap up.

So, first of all, I want to say a massive, massive thank you on behalf of all four of us for having come and spent a full half day as asked of you. I hope you all think it's been a fantastic conversation.