When is active surveillance the right choice for intermediate-risk prostate cancer patients? In this episode of BackTable Urology, Dr. Claire de la Calle, Assistant Professor of Urology at the University of Washington, joins Dr. Ruchika Talwar to unpack how active surveillance has evolved beyond low-risk disease and why select Grade Group 2 patients may be appropriate candidates now with thoughtful patient selection.

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SYNPOSIS

The conversation explores emerging tools that can refine surveillance decisions, including PSA density, MRI findings, genomic classifiers, and the growing role of AI-assisted pathology. Dr. de la Calle emphasizes the importance of nuanced patient counseling, acknowledging anxiety and long-term risk while reinforcing that time on active surveillance can be a meaningful win when oncologic outcomes remain comparable to upfront treatment.

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TIMESTAMPS

00:00 - Introduction
02:58 - Current Evidence
05:03 - Patient Selection Criteria
12:11 - Importance of PSA Density and Monitoring Protocols
18:12 - Pathology and Genomic Testing
32:18 - Future Directions and Research
36:33 - Key Takeaways

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RESOURCES

ProtecT Trial: Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer
https://www.nejm.org/doi/full/10.1056/NEJMoa2214122

Canary PASS Study
https://canarypass.org/

Genomic Classifier Performance in Intermediate-Risk Prostate Cancer: Results From NRG Oncology/RTOG 0126 Randomized Phase 3 Trial
https://pubmed.ncbi.nlm.nih.gov/37137444