Investigators evaluate delayed prostatectomy following active surveillance


"It's no surprise that there are many people interested in active surveillance and how we can be doing it better," says Kevin Shee, MD, PhD.

In this video, Kevin Shee, MD, PhD, describes the background for 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.


Please describe the background for this study.

We all know that active surveillance is the standard of care for low-risk prostate cancer. This is endorsed by all of our major guidelines, the AUA, the EAU, the National Comprehensive Cancer Network. So I think it's no surprise that there are many people interested in active surveillance and how we can be doing it better. One of the more concerning studies was done by the AUA Quality Registry, the AQUA study, by Dr. Cooperberg here at UCSF, showing that adoption of active surveillance is actually still suboptimal. I think the numbers, although they have increased from the past, it's from about 27% to 60%, in the past few years or so, we obviously would like to see that percentage much higher. And I think part of the reason why providers are worried about adopting active surveillance for some of these patients is that they're just worried that some of these patients in their initial biopsy may have been under sampled or they may have been missing higher risk disease that may end up posing a problem for the patient later on. And so I think in this setting, sometimes they're more willing to suggest the need for surgery or radiation or more definitive therapy for some of their patients that we think will do well on active surveillance. That was really the background of the study, and we wanted to investigate, for patients that, for example, do have low-risk disease initially and upgraded while on active surveillance, we wanted to see if the definitive therapy was pushed out, say, 12 months after an upgrade compared to patients who either got surgery right away, or were on active surveillance and got surgery, we wanted to study whether or not that delay really made a big difference.

This transcription was edited for clarity.

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