Dr. Shee on delayed prostatectomy after active surveillance

Opinion
Video

"These data really show that even in the patients who upgrade and have more severe disease than were initially expected, even if their surgery was delayed for 12 months after having this upgraded diagnosis, these patients did just as well from a recurrence perspective, compared to patients who got surgery right away," says Kevin Shee, MD, PhD.

In this video, Kevin Shee, MD, PhD, shares the take-home message from the European Urology study “The Impact of Delayed Radical Prostatectomy on Recurrence Outcomes After Initial Active Surveillance: Results from a Large Institutional Cohort.” Shee is a urology resident at the University of California, San Francisco.

Transcription:

What is the take-home message for the practicing urologist?

I would say the take-home message is something that maybe we've known for a long time, so it may not come as a surprise. But these data really show that even in the patients who upgrade and have more severe disease than were initially expected, even if their surgery was delayed for 12 months after having this upgraded diagnosis, these patients did just as well from a recurrence perspective, compared to patients who got surgery right away. I think what this really supports in our minds is the safety of active surveillance in patients with grade group 1, grade group 2 prostate cancer. We really want to provide this as evidence for those providers who are worried about putting their patients on active surveillance, just to say that there is time for the management of these patients, and that really, "missing" an opportunity for radical treatment is not as big of a concern as they may initially thought.

Is there anything you would like to add?

We were honestly kind of surprised that we didn't see a significant association with genomic testing and our recurrence outcomes. I think, right now, there's an array of different genomic testing tools that we have available, and I think really teasing out how to best utilize these in practice, especially in the active surveillance setting, is going to be really important moving forward. I think if we can really predict which patients are going to be the ones to upgrade or not just upgrade, but have overall survival differences or even metastasis differences, I think if we can really get at the best way to predict those adverse outcomes, that's going to be really crucial for moving the field forward. And I think genetic testing is going to be a big piece of that. We just have to figure out how to better explore those and better incorporate them into our practice.

This transcription was edited for clarity.

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