Who is a Candidate for "Active Surveillance"?
This summary is from the 2015 Prostate Cancer Conference where in his lecture, Matthew Cooperberg, MD, spoke on Active Surveillance. Dr. Cooperberghas has been invited to present his research findings at many national and international conferences. Here is the summary:
Why, Who and How - Who is a Candidate for “Active Surveillance”?
Is Active Surveillance (AS) safe?
- Mortality rates have been falling off since 1990’s start of PSA testing - very rapidly and dramatically. Perhaps early detection and better treatments. Very good news
- Fortunately uncommon
- Rare prostate tumors (behave like pancreatic cancer) PSA is 1, 1.2, - 20
- Can’t fix those with screening
Optimal treatment approach:
- Active surveillance
- Early local therapy
- Multimodal therapy
- Systemic therapy
- 1-10 (sum of points)
- 80% accurate in stratifying men in terms of low vs high risk
Active Surveillance not the same as “Watchful Waiting”
- Maintains intent to cure if necessary
- Delayed rather than avoid treatment
- Appropriate for men of all ages
- Requires reliable/active follow-up
Who should be eligible: See slide 14,15 &17
Gleason pattern 3 never metastasizes…..but….how do we know you only have Gleason 3??
Gleason 7 is extraordinarily heterogeneous… (3+4 or 4+3)…Pathologists don’t always agree.
Should young men be able to choose active surveillance?
Best time to screen a man is when he is young, late 40’s early 50’s before he has other issues that muddy the waters…BPH, prostatitis, etc
Matthew Cooperberg, MD is a genitourinary cancer specialist at the UCSF Helen Diller Family Comprehensive Cancer Center. He specializes in the diagnosis and management of genitourinary cancer, and using minimally invasive techniques to treat benign and malignant diseases. Dr. Cooperberg developed a new prostate cancer risk assessment tool called the Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score.