Timothy J. Daskivich, MD, assistant professor of surgery, Cedars-Sinai Medical Center, discusses active surveillance for patients with prostate cancer.

Active surveillance is currently used as a first-line treatment approach for the majority of patients with low-risk prostate cancer. Still, rates of active surveillance use in the community are not as high as some may think. In order for the rate of active surveillance to raise, uptake has to be driven by patient education and physicians, Daskivich says. Personally, Daskivich says that he tells his patients that sometimes no therapy is the best therapy.

Although high-grade cancers should be treated aggressively and carefully, Daskivich says that the majority of patients in the United States who are diagnosed with low-grade cancers need to be monitored by active surveillance as the primary, preferred strategy. This is in order to maximize quality of life and minimize morbidity, he explains.

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Timothy J. Daskivich, MD, assistant professor of surgery, Cedars-Sinai Medical Center, discusses active surveillance for patients with prostate cancer.
 

Dr. Daskivich Discusses Active Surveillance in Prostate Cancer

Timothy J. Daskivich, MD, assistant professor of surgery, Cedars-Sinai Medical Center, discusses the future treatment landscape of prostate cancer.

Daskivich’s hope is that active surveillance will be the primary therapy for very low-risk and the majority of low-risk prostate cancers. For select low-risk prostate cancers, high-intensity focused ultrasound (HIFU) or other minimally invasive and minimally morbid treatments will be used for those patients who need treatment, states Daskivich. Currently, HIFU is only approved in the United States for prostate tissue ablation, but it has demonstrated efficacy as a treatment for patients with prostate cancer. HIFU should be used sparingly, as to avoid overtreatment in patients with very low-risk tumors.

For favorable-risk, low-volume, localized, intermediate-risk tumors, HIFU will become the standard of care, predicts Daskivich. For unfavorable, intermediate-risk and higher tumors, the evidence suggests that, currently, surgery and radiation are the appropriate therapies. Time will tell, concludes Daskivich.

Dr. Daskivich on the Future Landscape of Prostate Cancer

Timothy J. Daskivich, MD, assistant professor of surgery, Cedars-Sinai Medical Center, discusses developing and available imaging modalities in prostate cancer.

One of the new cutting-edge techniques for patients with clinically localized prostate cancer is high-intensity focused ultrasound. This has been around the United States since October 2015, and it enables focal treatment of prostate tumors rather than whole-gland treatment. This maximizes cancer control while minimizing morbidity, Daskivich says.

The multi-parametric MRI is an excellent modality for identifying high-grade tumors. It has a 20% miss rate, and Cedars-Sinai Medical Center has developed a platform for high-resolution MRI that improves resolution over multi-parametric MRI by about six-fold, he adds. It identifies 60% of tumors that are invisible to multi-parametric MRI.

PET-MRI is another modality, but it is only available at a handful of centers across the United States; Cedars-Sinai Medical Center is one of them. Ongoing clinical trials are investigating the use of PET tracers like fluciclovine to identify tumors within the prostate gland.

Timothy J. Daskivich, MD

Articles

Dr. Daskivich Discusses Active Surveillance in Prostate Cancer

Dr. Daskivich on the Future Landscape of Prostate Cancer

Dr. Daskivich on Imaging Modalities in Prostate Cancer