Laurence Klotz, MD, FRCSC, presented “Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions” for the Grand Rounds in Urology audience in March 2021.
How to cite: Klotz, Laurence. “Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions” March 2021. Accessed May 2021. https://grandroundsinurology.com/active-surveillance-2021-patient-selection-monitoring-and-innocuous-interventions/
Active Surveillance 2021 – Patient Selection, Monitoring, and Innocuous Interventions: Summary
In the third part of a Platinum Lecture trilogy on active surveillance, Laurence Klotz, MD, FRCSC, Professor of Surgery and holder of the Sunnybrook Chair of Prostate Cancer Research at the University of Toronto, discusses patient selection, monitoring, and innocuous interventions for active surveillance of prostate cancer.
He begins by summarizing the evidence against treating young men differently in terms of placing them on active surveillance or not. He explains that younger men have a lower risk of upgrading on active surveillance and a relatively greater risk of sexual side effects from treatment compared to older men. Dr. Klotz then considers whether active surveillance is safe in Black men, citing a study that found higher rates of progression in treatment and progression in Black patients compared to white patients, but no difference in metastasis or mortality, indicating that active surveillance is safe for this group. Dr. Klotz also looks at whether active surveillance is safe for patients with grade group 2 cancer, summarizing several studies which indicate that careful patient selection is pivotal in this group, but also that active surveillance can be a good option for some patients in this cohort. Dr. Klotz observes that biomarkers are helpful in patient selection here, and emphasizes the benefits of compliance with active surveillance biopsy protocols. Dr. Klotz continues his presentation with a discussion of innocuous interventions for patients on active surveillance. Regardless of whether these interventions actually prevent prostate cancer progression, these interventions, including smoking cessation, dietary modification, and regular exercise, can help patients feel proactive, and most of them have other health benefits. There is also some evidence that simple interventions like taking vitamin D, a low-dose statin, and metformin on a daily basis could reduce prostate cancer progression. Dr. Klotz concludes with a summary of all three parts of his lecture trilogy.
For more on active surveillance for prostate cancer, check out our collection page for the 2020 International Prostate Cancer Update!