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PEER-TO-PEER CLINICAL CONVERSATION
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Challenges in Transitioning Men from Active Surveillance to Watchful Waiting
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Lisa Lowenstein, MD, PhD, RD
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| Zachary Klaassen speaks with Lisa Lowenstein about transitioning men from active surveillance to watchful waiting in prostate cancer management. Dr. Lowenstein shares insights from her research on patient and clinician perspectives, highlighting the challenges of convincing men to reduce their monitoring intensity.
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Highlights from the 2024 South Central Section of the AUA Annual Meeting
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| Transitioning Men to Watchful Waiting |
| Lisa Lowenstein, PhD, MPH, RD |
| Lisa Lowenstein discusses the challenges and strategies for transitioning prostate cancer patients from active surveillance to watchful waiting. She highlighted that patients often resist reducing monitoring due to concerns about undetected progression, while clinicians find de-escalating care easier than stopping it altogether. Dr. Lowenstein emphasized the role of shared decision-making and decision support tools to ease the transition for patients, especially those with limited life expectancy or multiple comorbidities. |
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| Active Surveillance for Intermediate Risk Prostate Cancer: Pro
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| Lisly Chery, MD
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| Lisly Chery highlights active surveillance as a viable option for select men with favorable intermediate-risk prostate cancer, particularly those with limited Gleason pattern 4 (<5%). While active surveillance is universally endorsed by major cancer organizations, Dr. Chery emphasized the importance of carefully assessing the amount of Gleason pattern 4 in intermediate-risk patients, as it significantly predicts outcomes. The ProtecT trial supports this approach, showing no survival difference between treatment and monitoring at 15 years for some intermediate-risk patients.
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| Active Surveillance for Low Volume Gleason Grade Group 2 Disease: Con
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| Aaron Laviana, MD, MBA
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| Aaron Laviana argues against active surveillance for low-volume Gleason Grade Group 2 prostate cancer, cautioning that these patients often progress to needing treatment despite initial surveillance. He emphasized the need to consider factors such as PSA density, cribriform patterns, and the percentage of Gleason pattern 4 disease, which are associated with higher risks of adverse outcomes. Dr. Laviana suggested that active surveillance should be approached cautiously
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| Focal Therapy in Prostate Cancer |
| Xiaosong Meng, MD, PhD |
| Xiaosong Meng discusses focal therapy as an alternative to active surveillance or definitive treatment for prostate cancer, especially for low- to intermediate-risk cases. Dr. Meng emphasized that patient selection is essential, requiring organ-confined intermediate-risk disease, visible lesions on MRI, and the patient’s commitment to follow-up. |
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| Clinical Trial Updates for Treatment of Metastatic Prostate Cancer
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| Elizabeth Wulff-Burchfield, MD
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| Elizabeth Wulff-Burchfield presented updates on recent significant clinical trials for metastatic prostate cancer treatments, focusing on three specific stages of the disease: High-Risk Biochemical Recurrence, Metastatic Hormone-Sensitive Prostate Cancer, and Metastatic Castrate-Resistant Prostate Cancer. Her presentation covered high-impact systemic therapy trials in each of these stages, offering insights into evolving therapeutic strategies for metastatic prostate cancer at varying stages of progression.
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