Dr Morris on Active Surveillance in Low- and Intermediate-Risk Patients With Prostate Cancer

David Morris, MD, FACS, practicing urologist, Advanced Therapeutics Center, Urology Associates of Nashville, discusses the best practices for active surveillance in low- and intermediate-risk patients with prostate cancer, highlighting factors to look for in patients undergoing active surveillance that may point to the need for further treatment.

At the 2023 LUGPA Annual Meeting, Morris participated in a discussion on active surveillance in patients with prostate cancer that highlighted the enhanced adoption of this approach for appropriately selected low-risk patients within the field of urology. A growing consensus emphasizes the need for a continued collective effort to advocate for active surveillance among low-risk patients who stand to benefit the most by avoiding the adverse effects associated with certain prostate cancer therapies, Morris explains. In the intermediate-risk population, the oncologic focus shifts toward a model centered on shared decision-making with the patients, he states. This model involves weighing the benefits and limitations of delaying therapy against initiating aggressive upfront treatment, Morris adds.

Various tools, such as genomics and magnetic resonance imaging (MRI), play a pivotal role in refining risk assessment, thereby facilitating more tailored and appropriate shared decision-making discussions, he expands. Typically, prostate-specific antigen (PSA) kinetics will serve as initial metrics for many practitioners to determine the necessity for further confirmatory tests, such as MRIs or biopsies, Morris emphasizes. Treating patients for prostate cancer directly from a period of active surveillance solely based on PSA levels is not common practice because PSAlevels can be influenced by various factors, such as prostate size, and thus may be misleading, he states.

AR5 inhibitors are a potential strategy for managing prostate cancer in men under active surveillance, as they may reduce the effects of fluctuations in PSA levels, Morris continues. However, the consensus in the urology field leans more toward using changes in biopsy grades or significant alterations observed in MRI results as primary indicators to transition towardactive treatment, he concludes.