Sigrid V. Carlsson, MD, PhD, MPH, presented “Prostate Cancer Active Surveillance in 2019” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.
How to cite: Crawford, E. David “New Applications and Clinical Possibilities in Prostate Cancer with Micro-Ultrasound” January 26, 2019. Accessed Nov 2024. https://grandroundsinurology.com/prostate-cancer-active-surveillance-in-2019
Prostate Cancer Active Surveillance in 2019 – Summary
Sigrid V. Carlsson, MD, PhD, MPH, reviews recent guidelines regarding patient selection and protocols for prostate cancer active surveillance. She provides methods for counseling patients who would benefit from active surveillance, but experience anxiety from the prospect of foregoing aggressive therapy.
Abstract:
Only a small proportion of men with prostate cancer die from the disease. Treatment with radical prostatectomy leads to worse long-term morbidity compared to active surveillance. Many trials, such as the PIVOT trial, have confirmed the safety of active surveillance in patients with low-risk prostate cancer. Even so, many patients with low-risk disease choose treatment over active surveillance. Clinicians must make informed decisions regarding which patients should undergo active surveillance and which should proceed to therapy.
This presentation provides a framework for decision-making between active surveillance and active treatment, especially in patients with intermediate-risk prostate cancer, and when to offer active treatment to those already on active surveillance. The conversation will also review recent guidelines on selecting the optimal candidates and protocols for active surveillance.
Patient anxiety is a significant issue to address in patients both on, or choosing to go on, active surveillance. A common sentiment among patients with recently diagnosed localized prostate cancer is the desire to “get rid of” or “cure” the disease with aggressive therapy. Data from Memorial Sloan Kettering Cancer Center (MSKCC) demonstrated that patients on active surveillance commonly experience cancer-specific anxiety initially, then report low levels of anxiety over time as they adjust to their program.
This presentation will discuss methods for lessening this anxiety in patients. These methods include changing the nomenclature of the prostate cancer grade groups to destigmatize low-risk disease, a systematic approach for counseling these patients from MSKCC.
About the International Prostate Cancer Update
The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management from diagnosis to treating advanced and metastatic disease. Dr. Carlsson presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.
ABOUT THE AUTHOR
Sigrid V. Carlsson, MD, PhD, MPH, is Director of Clinical Research at Memorial Sloan Kettering Cancer Center’s (MSKCC) Josie Robertson Surgery Center and Assistant Attending Epidemiologist, with dual appointments in MSKCC’s Departments of Surgery (Urology Service) and Epidemiology and Biostatistics. Her line of research focuses on screening and early detection of prostate cancer, including multiplex testing and risk-stratified strategies that incorporate clinical information, biomarkers and magnetic resonance imaging, as recently funded by an NIH/NCI U01 award (PI: Carlsson).
Dr. Carlsson also serves as Associate Professor of Experimental Urology affiliated with the Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, in Sweden, where she is an investigator of two large randomized controlled trials of prostate cancer screening (GOTEBORG-1&2), as recently published in the New England Journal of Medicine (Hugosson J, et al. N Engl J Med 2022). In addition, Dr. Carlsson is Adjunct Senior Lecturer in the Department of Translational Medicine in the Division of Urological Cancers in the Medical Faculty at Lund University, Lund, Sweden.
Dr. Carlsson recently completed a K22 career development award from the NIH/NCI to improve shared decision-making for breast and prostate cancer screening. She serves on the National Comprehensive Cancer Network (NCCN) and is a panel member for the American Urological Association (AUA) guidelines for early detection of prostate cancer. Before pursuing postdoctoral studies in urologic oncology at MSKCC, Dr. Carlsson was a physician in Sweden. She earned her MD and PhD from Gothenburg University in Sweden and earned an MPH from Harvard TH Chan School of Public Health in Boston, Massachusetts.
