Active Surveillance 2022: Who Qualifies, Who Does Not and How Should it be Monitored

Laurence Klotz, MD, outlines recent progress in active surveillance (AS), highlighting molecular genetics of GG1 vs. higher grade cancers, patient selection, germline testing, imaging, biomarkers, predictive nomograms, modeling, long-term outcomes, follow-up strategies, the tumor microenvironment, and dietary modifications. Dr. Klotz summarizes current AS follow-up strategy and explains that an emerging strategy is dynamic risk profiling with accurate biomarkers that will replace most serial biopsies.
More from Dr. Klotz on Grand Rounds in Urology: grandroundsinurology.com/auth...

[@janetw9430]

The 3T MRI, no contrast, was done in May with no biopsy. He was put on watchful waiting with MRI once a year and PSA test twice a year.
Prostate gland measures 6.6, 5.5, 4.4 centimeters on CC, TR and AP dimensions respectively with
estimated volume of 84 cc and PSA density of 0.063 ng/ml/cm3.
9.5 mm ill-defined nodule with obscured margins are noted within posterior medial aspect of left
peripheral zone at mid gland which show mild hypointense signal on ADC and mild hyperintense signal
on high B value DWI sequences likely representing PI-RADS 2/3 lesion. No other peripheral zone lesion
is noted. PSA is 4.86.

[@michealwood8354]

Great presentation. For the diet I will add that the vegetarian diet completely eased my bph issues.

[@justdoesntaddup8620]

The squeeze is on AS now, time reduced to explain, we’ll that’s been on from the start. Try being the layman patient who couldn’t explain the difference between a virus and an infection, then imagine trying to understand and decide on the PCa and the correct treatment plan for possibly the most complex matter on the medical landscape. .
Remember, the medical profession sees 10 experience years post university as the accepted benchmark of training and understanding recognition of Urology. So you recon you understand it in just a few months?
On the other side one is being advised and manoeuvred by those who stand to make scores of thousands from aggressive treatment.
Decisional conflict much?
Influenced shared decision much?