The UroOnc Minute: Active Surveillance for Intermediate-risk Prostate Cancer, with Michael Leapman, MD, MHS

In this inaugural episode of The UroOnc Minute from Urology Times, host Adam Weiner, MD, sits down with Michael S. Leapman, MD, MHS, associate professor of urology at Yale School of Medicine, to discuss evolving approaches to active surveillance in prostate cancer, particularly among patients with intermediate-risk disease.

Leapman, a clinician-scientist whose research focuses on health services and prostate cancer management, highlights the shifting landscape of patient selection for active surveillance. As the pool of low-risk cases shrinks due to more selective and precise biopsy practices, a growing proportion of patients fall into the intermediate-risk category—many of whom may safely defer treatment with proper monitoring.

During the conversation, Leapman outlines how he integrates multiple data sources to individualize care, including histologic features such as the percentage of pattern 4 disease, MRI findings, and tissue-based genomic assays like Decipher. He also emphasizes red-flag features such as cribriform or intraductal carcinoma that may warrant a more aggressive approach.

Looking ahead, Leapman calls for greater standardization in active surveillance practices, noting substantial national variation in how clinicians monitor intermediate-risk patients. He advocates for clearer guideline frameworks to bring consistency to imaging frequency, biopsy intervals, and biomarker use, which will improve both patient outcomes and clinical confidence in this expanding area of prostate cancer management.