Dr. Behfar Ehdaie is a urologist at Memorial Sloan Kettering Cancer Center in New York City.
Could low-risk patients just as easily choose active surveillance? Is it just patient choice: active surveillance or partial-gland ablation?
Dr. Ehdaie: I think active surveillance, partial-gland ablation, or focal therapy, and whole-gland treatments, which include radical retropubic prostatectomy or radiation therapy, exist on a spectrum for disease management in prostate cancer.
I do believe that there are patients who we would all agree are very good candidates for active surveillance. Men who’ve been diagnosed with Gleason 3+3 prostate cancer fall into this category. I think our discussion about men who may be eligible for focal therapy or partial-gland ablation would include men with intermediate risk prostate or Gleason 3+4 or 4+3 prostate cancer.
Of course, some of the men with low-volume Gleason 3+4 prostate cancer in foci within the prostate gland would also be considered very good candidates for active surveillance. It’s important that all patients are offered all treatments and that those treatments are explained in detail at every consultation.