The UroOnc Minute: Keeping Patients Engaged in Active Surveillance, With Lourdes Guerrios-Rivera, MD, MSc

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, recorded at the 2026 American Urological Association Annual Meeting, host Adam B. Weiner, MD, is joined by Lourdes Guerrios-Rivera, MD, MSc, for a discussion on maintaining patient engagement during active surveillance for prostate cancer. Guerrios-Rivera is an assistant professor at the University of Puerto Rico School of Medicine and an attending at the VA Caribbean Healthcare System.

As the use of active surveillance continues to expand, including among select patients with favorable intermediate-risk disease, Guerrios-Rivera emphasizes that successful surveillance extends far beyond ordering periodic prostate-specific antigen (PSA) tests and imaging studies. Instead, it requires a thoughtful, patient-centered approach that begins with education. She discusses the importance of dedicating sufficient time to conversations about diagnosis, treatment goals, and follow-up expectations, noting that many patients struggle with the psychological burden of living with an untreated cancer. This anxiety and concerns about disease progression can influence adherence to surveillance protocols and, in some cases, lead patients to pursue definitive treatment despite favorable disease characteristics.

The discussion also highlights practical strategies for improving long-term follow-up. Guerrios-Rivera explains that patients are more likely to remain engaged when they understand that active surveillance follows a structured, evidence-based pathway rather than a passive “wait and see” approach. Clear communication regarding the timing of PSA testing, imaging, biopsies, and potential triggers for intervention can help reduce uncertainty and foster trust. She also addresses the role of family involvement, cultural considerations, health care access, and patient navigation programs in supporting adherence to surveillance recommendations.

Looking ahead, Guerrios-Rivera shares her perspective on future opportunities to improve active surveillance outcomes through patient education initiatives, lifestyle interventions, and emerging technologies, including artificial intelligence–driven tools that may help personalize care and identify patients at risk of disengagement. Ultimately, she argues that empowering patients to take an active role in their care is essential to the long-term success of active surveillance programs and the delivery of high-quality prostate cancer care.