Dr. Touijer suggests that there are three factors that cause this issue: the doctor, the patient, and the disease. There is a Japanese study where they evaluated the preferences and knowledge of doctors in terms of treatments for prostate cancer, however, most doctors preferred not to opt for active surveillance and the vast majority were not sure of the results and were concerned about the oncological results in the long term. Some other doctors were concerned about the patient's anxiety. In another North American study, they think it's a good strategy to do active surveillance but they also think that it is not used as often as it should.
They mention that in their institution they identified a decrease in the use of AS and they identified that it was due to the way in which this strategy is offered to patients.
He believes that we should turn active surveillance into the standard of treatment and not as an option in patients with low-risk prostate cancer and that more education is needed from both doctors and patients.
There are different strategies for monitoring patients in active surveillance, PSA, digital rectal examination, MRI, a transrectal prostate biopsy (TRB), genomic tests, with biopsy being the most useful so far. TRB decides whether the patient can continue with monitoring or not.
He mentioned the most common follow-up schemes.
Currently, the use of AS has increased exponentially at the Memorial Sloan Kettering Cancer Center. They use annual confirmatory biopsy and subsequently biopsies every 3 years, using a baseline MRI and then every 18 months.
Touijer considers that AS is a strategy that can be useful in intermediate risk cancer as long as the scheme is modified based on the risk.
It concludes that one should not be afraid to initiate active surveillance in patients with low risk since the evidence in the literature is enough to recommend it as a standard of treatment in a patient with low risk.
Presented by: Karim A. Touijer MD MPH, Memorial Sloan Kettering Cancer Center New York City, USA
Written by: J. Jesús Cendejas-Gómez MD, Resident of Urology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico and Ashish M. Kamat, MD, Professor of Urologic Oncology, MD Anderson Cancer Center, Houston, TX at the 2018 Congreso de la Asociación Mexicana de Urología Oncológica – July 25-28, 2018, Acapulco, GRO México