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Active Surveillance in 2023 – Matthew Cooperberg, MD

Dr. Matthew Cooperberg, MD, MPH, of UCSF, gave a must-see masterful presentation on Active Surveillance (AS) at the annual meeting in October of the Prostate Cancer Research Institute (PCRI).
He has been a champion and lately has been a leader in an effort to redefine Gleason 3+3+6 (Grade Group 1) lesions as noncancers to reduce emotional distress and financial toxicity, such as insurance discrimination, in patients. This is controversial. Patients, pathologists and urologists alike are divided.

Cooperberg said: “We should not call this a cancer, okay? I’m in a small but growing minority of folks that are saying this. … The tide is kind of shifting on this. And they did it by age [of practitioners], right? So the older generation, especially in pathology, are very committed to this is cancer. It looks like cancer. It’s cancer.

5:17 The Number of people on Active Surveillance is increasing?
5:37 Proper to diagnose someone with an insignificant tumor?
5:53 Do I have “cancer”?
6:28 What is cancer?
8:05 PSA is the best screening biomarker in the history of oncology if used well
8:22 Newer screening practices
9:33 Does this mean Grade Group 1, 3+3, Dr. Cooperberg says not cancer?
10:34 GG1 is not a normal finding, but A.S. is recommended
11:58 Continuum of Biology
12:57 Arbitrary line drawn for cancer
13:45 What if we don’t call it cancer?
14:49 Why the largest PSA screening trial failed
19:25 Should men go for PSA screening?
20:57 Median PSA is 0.7 between 45 and 50
21:22 If it’s under 1.0, you’re done
22:30 PSA values vary
23:23 What does act on PSA mean?
24:50 Liquid tests
25:54 Why not have everyone get an MRI?
26:23 What inter-observer variability exists with MRI’s?
32:27 Cooperberg screening policy
33:59 DRE (Digital Rectal Exam)
40:26 How should a man choose his localized treatment?
43:15 Is there an age limit for Active Surveillance?
45:45 Mental health considerations
49:31 Confirmatory biopsy
52:01 Why can’t everyone diagnosed get a BRCA/Genetic test?
56:10 What do we do differently now we know you have a BRCA mutation?
1:00:25 What about Pathology?
1:01:10 Sub-types of Pattern 4
1:02:38 Cribriform patterns
1:04:14 All GS 3+4 is not created equal
1:05:25 Is PSA density of 0.15 a valid cutoff for Active Surveillance?
1:05:50 Intraductal/large cribriform patterns for Active Surveillance?
1:06:54 Cancer is driven by the worst corner of it
1:08:06 Most Gleason 7’s sent for genomic test
1:08:34 Intraductal worst pattern followed by cribriform
1:09:24 DRE’s for Active Surveillance?
1:09:48 How often for PSA’s/MRI’s?
1:10:26 Active Surveillance 2023 (one opinion)
1:12:59 How do you choose your urologist?
1:15:00 Do PSA kinetics matter?
1:16:05 MEAL trial
1:18:22 What about exercise?
1:19:35 What about testosterone replacement therapy?
1:21:32 What about the two types of PSA tests?