FOIU 2018: Active Surveillance for Intermediate Risk Prostate Cancer - AGAINST

Tel-Aviv, Israel (UroToday.com) Laurence Klotz, MD debated against active surveillance (AS) for intermediate-risk prostate cancer (IRPC). He began with the known data on Gleason grade group 1, and group 2. Gleason score of 3 resembles normal cells in most cases and has a metastatic potential of zero. Conversely, Gleason 4 has a significant metastatic potential. Many Gleason 3+4 cancers are clinically insignificant but some are lethal. The stakes are much higher and the risks much greater.

FOIU 2018: Active Surveillance for Intermediate Risk Prostate Cancer - FOR

Tel-Aviv, Israel (UroToday.com) Larry Goldenberg, MD demonstrated his support for using active surveillance (AS) in intermediate-risk prostate cancer (IRPC). Goldenberg began his talk by stating that not all IRPC is the same. It is agreed by most, that unfavorable IRPC requires treatment.  Conversely, favorable IRPC require more stringent follow-up but deferred therapy is not dangerous. Ultimately, it comes down to a man’s risk threshold (his comfort zone).

FOIU 2018: Can MRI Replace Biopsy in Men on Active Surveillance? - YES

Tel-Aviv, Israel (UroToday.com) Arnauld Villers, MD presented and explained his support of multiparametric MRI (mpMRI) replacing biopsy in men on active surveillance (AS) of prostate cancer (PC). According to the EAU guidelines, there are considerable variations among studies regarding patient selection, follow-up schedule, and the use of confirmatory or repeat biopsy and MRI. 

FOIU 2018: Can MRI Replace Biopsy in Men on Active Surveillance? - NO

Tel-Aviv, Israel (UroToday.com) Reiter presented his view why serial MRI cannot replace biopsy in patients on active surveillance (AS) in prostate cancer (PC) patients. According to Reiter MRI is an excellent (although not perfect) for identification of “significant” tumors”. It has a high negative predictive value (NPV) that aids patient stratification for AS. Therefore, many Gleason grade group 1 (GGG1) tumors are not visible by MRI, and so there is nothing to follow. There is lack of evidence that serial MRI can add to or replace biopsy while on AS.

FOIU 2018: Proper Selection of Patients for Active Surveillance – Primum Non Nocere?

Tel-Aviv, Israel (UroToday.com) Mitchell C. Benson, MD gave a talk on the selection of patients for active surveillance (AS). The Epstein criteria for AS with 95% positive predictive value (PPV) include:

  • Gleason 6 or below 
  • PSA density<0.15
  • <3 cores involved 
  • <50% of any single core involved 

FOIU 2018: Active Surveillance In Young Men

Tel-Aviv, Israel (UroToday.com) Adam Feldman, MD gave a talk on the use of active surveillance (AS) for young patients. AS has become an accepted management strategy for very low risk, low risk, and select favorable intermediate-risk prostate cancer (PC). Although there is a large amount of data supporting AS as a safe strategy, there is a paucity of data in young men.

FOIU 2018: Critical Role of Pathology for Active Surveillance Criteria and Definition of “Progression”

Tel-Aviv, Israel (UroToday.com) Jonathan Epstein, MD, gave an overview of the active surveillance (AS) criteria for prostate cancer (PC), including criteria for selection, follow-up, the trigger for intervention, and change in reporting grade. The criteria for selecting patients for AS are numerous and include:
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