Clinical “Pearls” in Managing Patients on Surveillance

Abstract

Managing patients with active surveillance requires many skills. It requires knowledge of the natural history of prostate cancer and a familiarity with the implications of every facet of prostate cancer pathology. It requires the ability to assess patient comorbidity and accurately predict life expectancy. It requires the ability to interpret the implications of PSA kinetics and imaging studies and accurately communicate this to the patient. It requires empathy to facilitate an appreciation of individual patient’s value systems and expectations. Above all, it requires excellent communication skills. The risks and benefits of active surveillance, the favorable natural history of low-risk prostate cancer, and the quality of life effects of therapy must be explained in a clear and sympathetic manner. In this chapter, we will describe many techniques developed over the last 15 years to facilitate patient understanding and acceptance of the active surveillance approach. These are practical and empiric. They include the “talking points” that we have found most useful in making the case for surveillance, the strategy for employing these, and the references that they are based on. We also address the practical aspects of patient selection and triggers for intervention.