By Howard Wolinsky, The Active Surveillor
Doctors agree that active surveillance (AS) is the best approach for men with very low-, low and favorable intermediate-risk prostate cancer, a top Canadian prostate researcher told Tri-Cities Prostate Cancer Support and Awareness Group in Vancouver, British Columbia on February 1.
But Celestia “Tia” Higano, MD, an adjunct professor in the Department of Urologic Sciences at the University of British Columbia, told the 70 attendees that there is no consensus on how to provide active surveillance
She stressed that the Canadian Urological Association and the American Urological Association generally agree about the basics of AS.
However, she said, “One of the things that is a fact is at the moment is there is no acceptable recipe for how to carry out active surveillance.”
When patients compare notes, they become acutely aware of the differences in protocols.
“Some clinicians will say we need to get serial PSAs every few months whereas a lot of the recommendations say don’t get the PSA more than every six months because we know that PSA especially with a prostate intact tends to fluctuate anyway. No one has decided when or how often the biopsy should be repeated. Rectal exams are suggested every one to two years.
“Biopsies could be done with or without the assistance of a multiparametric MRI. Now, multiparametric MRIs, there are not a lot of those in Canada. I think it’s coming and there will be more. I remember when I was a resident at the Mayo Clinic. They were just starting to come out with regular MRIs. I remember somebody saying the Mayo Clinic has more MRIs than all of Canada. I think eventually, the technology as it’s regarded as more and more useful will be more available on [the Canadian] side of the border.”
Overdiagnosis and overtreatment of very low-risk, low-risk, and favorable intermediate-risk prostate cancer led to the development of active surveillance, close monitoring of cancer to avoid the side effects of surgery and radiation, said the researcher, who has been the medical director of the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre since 2013.
Higano, who has practiced on both sides of the border, explained the similarities and differences in medical practice between the United States and Canada.
To view the video, go to YouTube here: