Active Surveillance vs. Intervention: Making the Choice | Prostate Talk

Description

In this episode, we welcome Dr. Michaël Baboudjian from Marseille, France, to discuss the topic of Active Surveillance for prostate cancer.

Discover:

The principles of active surveillance
The key elements of an effective surveillance strategy
The collaboration between radiologists and urologists
The criteria for selecting patients eligible for active surveillance
Finding the right balance between under- and overtreatment

Hosted on Ausha. See ausha.co/privacy-policy for more information.

Transcription

Speaker #0
This podcast is created by Coelis.
Speaker #1
First thing that I say to my patients, if I take 100 patients, I follow them 10 years with a low grade disease, 10 years after, no one would die from prostate cancer. First point that is super reassuring for the patient.
Speaker #0
Dear prostate protectors, welcome back to another enlightening episode of Prostate Talk, where we dive deep into the gland that make the man, or at least a good portion of his PSA levels. Today, we are not slicing, freezing or zapping anything yet. Instead, we are exploring a more subtle, strategic approach to prostate cancer called active surveillance. Before you imagine a doctor with a magnifying glass watching your prostate 24-7 relax, Active surveillance is all about keeping a close eye on cancer that's not quite misbehaving yet. It's a game of patience, precision, and knowing exactly when to act and when to chill. Helping us decode this nuanced approach is none other than Dr. Baboudjian, all the way from the sunny, olive-oil-soaked city of Marseille. Here's to share why sometimes the best treatment might just be doing nothing for now, but doing it very, very well. So sit back, stay alert, but not alarmed, and let's get into why watching and waiting isn't the same as ignoring. Hello, Dr. Baboudian. We are really pleased to welcome you to our podcast, Prostatalk. Before we dive in, I just want to say that today's episode has a special flavor, not just because of the topic you're here to discuss, but also because for the first time ever we are recording from our hometown, the mountains, huge innovation to charge city of Grenoble. So yes, this one feels a little more personal. So Dr. Baboudian, thank you again. And how are you today?
Speaker #1
I'm very fine. Thank you for the invitation. I'm glad.
Speaker #0
Before talking about prostate cancer, could you please tell us more about yourself?
Speaker #1
Well, I'm 33 years old, urologist in Marseille, and my main clinical activities are prostate cancer and BPH.
Speaker #0
Well, during my research with the help of my behind-the-scenes team, of course, I came across your preference for transperineal prostate biopsy. Am I right?
Speaker #1
Yes. I switched from transrectal to transperineal biopsies three years ago, and now I do all my procedure under local anesthesia in consultation with a transperineal approach.
Speaker #0
And today, are you only performing transperineal biopsies or also transrectal? And what are the criteria of choice?
Speaker #1
Well, now I have switched to 100% of transperinale biopsies, and the first reason is we don't have any more infectious complications with transperinale biopsy. We don't use any more urinary culture before, we don't do antibioprophylaxis, and at the end we don't have any infection. Me with now more than 200 transperinale biopsies, I didn't experience any post-biopsy infection. So this is the main reason. The second point is about the detection of clinically significant prostate cancer. We have a lot of randomized trials on this topic with sometimes similar results, sometimes a superiority for the transpirinal biopsy. From my personal view, I'm almost sure, I'm really convinced that we do it better with a transpirinal approach.
Speaker #0
That's clear for me. Thanks for your input. Let's talk now about therapeutic strategies but not radical treatment or focal therapies. We'll talk about active surveillance. I know that you are interested in this topic. Could you please tell us more about it?
Speaker #1
Well, active surveillance principle is to delay or to avoid a radical treatment because the disease has a very low risk of distant progression and we want to postpone as much as possible side effects of radical treatments. So the indication of active surveillance has... really expanded during the last years.
Speaker #0
Okay, so to be sure to understand, I'm a patient and if the doctor says okay, we don't need to do any treatment, you just have to come back in six months just to see if everything is okay, that's the principle?
Speaker #1
Exactly, first thing that I say to my patients, if I take 100 patients, I follow them 10 years with a low-grade disease, 10 years after, no one would die from prostate cancer. First point that is super reassuring for the patient. So yes, I say to the patient I will follow you with PSA, with MRIs, sometimes with re-biopsy, but I try as much as possible to put the patient in a good way.
Speaker #0
Sounds very good for the patients and his quality of life. Maybe it's a little bit naive. Can we still speak about cancer when a patient is with active surveillance?
Speaker #1
Well, this is an ongoing debate that we have in the urology community, so you are making a good point. If we look at the histopathological data, easy-point prostate cancer is still associated with an invasion of the basal membrane, so it's still. cancer and we should call it a cancer. The main debate is about why people continue to operate patients with Hp cancer while we know that they have a super good prognosis as we have talked before. So maybe there are a lot of options that we can use to increase the number of active surveillance in Hp patients to stop treatment but saying to urologist it is not a the cancer to stop them doing surgery, it's a mistake.
Speaker #0
What are, according to you, the key points of a good active surveillance?
Speaker #1
The key for active surveillance is first a good MRI and a good interpretation of the MRI and then a good biopsy. And if the first biopsy, we can believe on it, if we do a good biopsy, a good targeted biopsy, we can go with active surveillance with good basic.
Speaker #0
You spoke about MRI. What is a good MRI?
Speaker #1
A good MRI is first the quality of the images and there is a score that evaluates the quality of the images. So this is the first point. Second point is a good radiologist and a good urologist looking together the result of the MRI, looking at the target and planning the biopsy shunt.
Speaker #0
So does it mean that before Making a biopsy to a patient, you talk with the radiologist, you check the patient's file folders, I don't know, with him, and discuss about the good choices that you have to do for the biopsy or the treatment?
Speaker #1
Yes. In my practice, most of patients do their MRI outside of the hospital. So all MRIs are centrally reviewed by my radiologist. I never do an MRI without rereading it with my radiologist. And this is the key. A good MRI, a good indication. and a good biopsy.
Speaker #0
And good teamwork as well. Are you currently doing research about it? Could you share the first result with us, maybe?
Speaker #1
Yes, we have started a European database on active surveillance, especially in patients with intermediate-risk prostate cancer. Because now, active surveillance is recommended for patients with low-risk prostate cancer, but for intermediate-risk, not yet. or for some very specific case and our wish is to expand the indication of active surveillance in patients with intermediate risk because we know that most of these patients have a very low risk of distant progression and we can postpone as much as possible again the side effects of the radical treatment.
Speaker #0
I understand and which patient can usually benefit from active surveillance and do you think it could be extended to other patients maybe?
Speaker #1
We take into account several parameters. First, and most important for me, is the MRI. We need to have an organ-confined disease, and we need a good analysis of the capsula to be sure that there is no risk for the patient to have an extra capsular extension of the disease and then to undertreat the patient. Second point is the result of the biopsy and the grading that we will have. Some people say that we need to have a low grade of pattern 4. maximum 10 or 20 percent. I think that it's not so important. The most important is the MRI and the PSA density because the PSA density will reflect the aggressiveness of the tumor.
Speaker #0
How can we ensure that this approach is adopted more widely by urologists and their patients?
Speaker #1
Well, we have some studies from the US showing that for intermediate risk patients, less than 10 percent have currently active surveillance offered by their urologist. There are probably several reasons for this, but I'm pretty sure that with data that we will implement in the next future, we will have more and more patients in active surveillance.
Speaker #0
What is the balance between over and under treatment today?
Speaker #1
That's a very good question. First, we need to discuss with all patients about the benefits and the risks that we have between active surveillance and active treatment. the main objective is to go through a reduction of the over and under diagnosis and evaluation of the disease. Because now with MRI, with a good targeted biopsy, now with PSMAPet, we have more and more data showing that we have a good diagnosis. And if we compare to the final pathology, if we do a prostatectomy, now biopsy trend to be close as much as possible to the final pathology.
Speaker #0
Interesting. And if active surveillance is no longer sufficient, what are the next steps?
Speaker #1
Well, it depends on why active surveillance is not anymore sufficient. But next step are usually focal therapy or active treatment, which could be radical prostatectomy or radiotherapy.
Speaker #0
And you, for your patient, what kind of treatment do you perform?
Speaker #1
Most of patients that I follow with active surveillance are young patients. I should acknowledge that most of these patients, when they go out of active surveillance, they have focal therapy or radical prostatectomy.
Speaker #0
Who is a young patient? What kind of age? I'm curious.
Speaker #1
I consider patients young if they are less than 70.
Speaker #0
Okay, great. I'm sure that many patients will be happy to hear that. So, Dr. Baboudjian, before ending this interview, could you please tell us more about your next plans? Not today, but in the future.
Speaker #1
We are now working a lot about changing our biopsy scheme, because we have changed first our biopsy approach, but now the aim is to change the biopsy scheme, and we want to eradicate systematic biopsies that lead to a lot of diagnosis of Yuzupran prostate cancer, and then active surveillance, and then patient has... for his long life, a passport with cancer that he will have to dress. So for me, finding an easy point on a patient is an error. And the next step is to change our biopsy scheme to avoid this diagnosis and to lower our active surveillance rate.
Speaker #0
It can be a nice topic for another episode, maybe. So we can wait to talk with you about that. As you may know, I like to ask my guest a surprise question. So... What is your favorite song, Dr. Baboujon?
Speaker #1
Well, I'm a very big fan of Charles Aznavour. Oh,
Speaker #0
wow. Great. We had a movie last year about his career, so good choice. Thank you. And I hope to see you soon in our podcast. Thank you. Huge thanks to our dedicated listeners. If you enjoyed the podcast, make sure to subscribe for more captivating content. Your support means the world. If you found this informative, quick favor please, drop up a 5-star review. Your feedback helps us grow and deliver quality insight. Have topics you'd love us to cover? Share your ideas in the comments or connect with us on social media. Your input guides the future of Pros That Talk. Thanks for being a crucial part of our community. For more Urology insights, Visit Curleez.com, stay tuned and see you next time.

Description

In this episode, we welcome Dr. Michaël Baboudjian from Marseille, France, to discuss the topic of Active Surveillance for prostate cancer.

Discover:

The principles of active surveillance
The key elements of an effective surveillance strategy
The collaboration between radiologists and urologists
The criteria for selecting patients eligible for active surveillance
Finding the right balance between under- and overtreatment

Hosted on Ausha. See ausha.co/privacy-policy for more information.

Transcription

Speaker #0
This podcast is created by Coelis.
Speaker #1
First thing that I say to my patients, if I take 100 patients, I follow them 10 years with a low grade disease, 10 years after, no one would die from prostate cancer. First point that is super reassuring for the patient.
Speaker #0
Dear prostate protectors, welcome back to another enlightening episode of Prostate Talk, where we dive deep into the gland that make the man, or at least a good portion of his PSA levels. Today, we are not slicing, freezing or zapping anything yet. Instead, we are exploring a more subtle, strategic approach to prostate cancer called active surveillance. Before you imagine a doctor with a magnifying glass watching your prostate 24-7 relax, Active surveillance is all about keeping a close eye on cancer that's not quite misbehaving yet. It's a game of patience, precision, and knowing exactly when to act and when to chill. Helping us decode this nuanced approach is none other than Dr. Baboudjian, all the way from the sunny, olive-oil-soaked city of Marseille. Here's to share why sometimes the best treatment might just be doing nothing for now, but doing it very, very well. So sit back, stay alert, but not alarmed, and let's get into why watching and waiting isn't the same as ignoring. Hello, Dr. Baboudian. We are really pleased to welcome you to our podcast, Prostatalk. Before we dive in, I just want to say that today's episode has a special flavor, not just because of the topic you're here to discuss, but also because for the first time ever we are recording from our hometown, the mountains, huge innovation to charge city of Grenoble. So yes, this one feels a little more personal. So Dr. Baboudian, thank you again. And how are you today?
Speaker #1
I'm very fine. Thank you for the invitation. I'm glad.
Speaker #0
Before talking about prostate cancer, could you please tell us more about yourself?
Speaker #1
Well, I'm 33 years old, urologist in Marseille, and my main clinical activities are prostate cancer and BPH.
Speaker #0
Well, during my research with the help of my behind-the-scenes team, of course, I came across your preference for transperineal prostate biopsy. Am I right?
Speaker #1
Yes. I switched from transrectal to transperineal biopsies three years ago, and now I do all my procedure under local anesthesia in consultation with a transperineal approach.
Speaker #0
And today, are you only performing transperineal biopsies or also transrectal? And what are the criteria of choice?
Speaker #1
Well, now I have switched to 100% of transperinale biopsies, and the first reason is we don't have any more infectious complications with transperinale biopsy. We don't use any more urinary culture before, we don't do antibioprophylaxis, and at the end we don't have any infection. Me with now more than 200 transperinale biopsies, I didn't experience any post-biopsy infection. So this is the main reason. The second point is about the detection of clinically significant prostate cancer. We have a lot of randomized trials on this topic with sometimes similar results, sometimes a superiority for the transpirinal biopsy. From my personal view, I'm almost sure, I'm really convinced that we do it better with a transpirinal approach.
Speaker #0
That's clear for me. Thanks for your input. Let's talk now about therapeutic strategies but not radical treatment or focal therapies. We'll talk about active surveillance. I know that you are interested in this topic. Could you please tell us more about it?
Speaker #1
Well, active surveillance principle is to delay or to avoid a radical treatment because the disease has a very low risk of distant progression and we want to postpone as much as possible side effects of radical treatments. So the indication of active surveillance has... really expanded during the last years.
Speaker #0
Okay, so to be sure to understand, I'm a patient and if the doctor says okay, we don't need to do any treatment, you just have to come back in six months just to see if everything is okay, that's the principle?
Speaker #1
Exactly, first thing that I say to my patients, if I take 100 patients, I follow them 10 years with a low-grade disease, 10 years after, no one would die from prostate cancer. First point that is super reassuring for the patient. So yes, I say to the patient I will follow you with PSA, with MRIs, sometimes with re-biopsy, but I try as much as possible to put the patient in a good way.
Speaker #0
Sounds very good for the patients and his quality of life. Maybe it's a little bit naive. Can we still speak about cancer when a patient is with active surveillance?
Speaker #1
Well, this is an ongoing debate that we have in the urology community, so you are making a good point. If we look at the histopathological data, easy-point prostate cancer is still associated with an invasion of the basal membrane, so it's still. cancer and we should call it a cancer. The main debate is about why people continue to operate patients with Hp cancer while we know that they have a super good prognosis as we have talked before. So maybe there are a lot of options that we can use to increase the number of active surveillance in Hp patients to stop treatment but saying to urologist it is not a the cancer to stop them doing surgery, it's a mistake.
Speaker #0
What are, according to you, the key points of a good active surveillance?
Speaker #1
The key for active surveillance is first a good MRI and a good interpretation of the MRI and then a good biopsy. And if the first biopsy, we can believe on it, if we do a good biopsy, a good targeted biopsy, we can go with active surveillance with good basic.
Speaker #0
You spoke about MRI. What is a good MRI?
Speaker #1
A good MRI is first the quality of the images and there is a score that evaluates the quality of the images. So this is the first point. Second point is a good radiologist and a good urologist looking together the result of the MRI, looking at the target and planning the biopsy shunt.
Speaker #0
So does it mean that before Making a biopsy to a patient, you talk with the radiologist, you check the patient's file folders, I don't know, with him, and discuss about the good choices that you have to do for the biopsy or the treatment?
Speaker #1
Yes. In my practice, most of patients do their MRI outside of the hospital. So all MRIs are centrally reviewed by my radiologist. I never do an MRI without rereading it with my radiologist. And this is the key. A good MRI, a good indication. and a good biopsy.
Speaker #0
And good teamwork as well. Are you currently doing research about it? Could you share the first result with us, maybe?
Speaker #1
Yes, we have started a European database on active surveillance, especially in patients with intermediate-risk prostate cancer. Because now, active surveillance is recommended for patients with low-risk prostate cancer, but for intermediate-risk, not yet. or for some very specific case and our wish is to expand the indication of active surveillance in patients with intermediate risk because we know that most of these patients have a very low risk of distant progression and we can postpone as much as possible again the side effects of the radical treatment.
Speaker #0
I understand and which patient can usually benefit from active surveillance and do you think it could be extended to other patients maybe?
Speaker #1
We take into account several parameters. First, and most important for me, is the MRI. We need to have an organ-confined disease, and we need a good analysis of the capsula to be sure that there is no risk for the patient to have an extra capsular extension of the disease and then to undertreat the patient. Second point is the result of the biopsy and the grading that we will have. Some people say that we need to have a low grade of pattern 4. maximum 10 or 20 percent. I think that it's not so important. The most important is the MRI and the PSA density because the PSA density will reflect the aggressiveness of the tumor.
Speaker #0
How can we ensure that this approach is adopted more widely by urologists and their patients?
Speaker #1
Well, we have some studies from the US showing that for intermediate risk patients, less than 10 percent have currently active surveillance offered by their urologist. There are probably several reasons for this, but I'm pretty sure that with data that we will implement in the next future, we will have more and more patients in active surveillance.
Speaker #0
What is the balance between over and under treatment today?
Speaker #1
That's a very good question. First, we need to discuss with all patients about the benefits and the risks that we have between active surveillance and active treatment. the main objective is to go through a reduction of the over and under diagnosis and evaluation of the disease. Because now with MRI, with a good targeted biopsy, now with PSMAPet, we have more and more data showing that we have a good diagnosis. And if we compare to the final pathology, if we do a prostatectomy, now biopsy trend to be close as much as possible to the final pathology.
Speaker #0
Interesting. And if active surveillance is no longer sufficient, what are the next steps?
Speaker #1
Well, it depends on why active surveillance is not anymore sufficient. But next step are usually focal therapy or active treatment, which could be radical prostatectomy or radiotherapy.
Speaker #0
And you, for your patient, what kind of treatment do you perform?
Speaker #1
Most of patients that I follow with active surveillance are young patients. I should acknowledge that most of these patients, when they go out of active surveillance, they have focal therapy or radical prostatectomy.
Speaker #0
Who is a young patient? What kind of age? I'm curious.
Speaker #1
I consider patients young if they are less than 70.
Speaker #0
Okay, great. I'm sure that many patients will be happy to hear that. So, Dr. Baboudjian, before ending this interview, could you please tell us more about your next plans? Not today, but in the future.
Speaker #1
We are now working a lot about changing our biopsy scheme, because we have changed first our biopsy approach, but now the aim is to change the biopsy scheme, and we want to eradicate systematic biopsies that lead to a lot of diagnosis of Yuzupran prostate cancer, and then active surveillance, and then patient has... for his long life, a passport with cancer that he will have to dress. So for me, finding an easy point on a patient is an error. And the next step is to change our biopsy scheme to avoid this diagnosis and to lower our active surveillance rate.
Speaker #0
It can be a nice topic for another episode, maybe. So we can wait to talk with you about that. As you may know, I like to ask my guest a surprise question. So... What is your favorite song, Dr. Baboujon?
Speaker #1
Well, I'm a very big fan of Charles Aznavour. Oh,
Speaker #0
wow. Great. We had a movie last year about his career, so good choice. Thank you. And I hope to see you soon in our podcast. Thank you. Huge thanks to our dedicated listeners. If you enjoyed the podcast, make sure to subscribe for more captivating content. Your support means the world. If you found this informative, quick favor please, drop up a 5-star review. Your feedback helps us grow and deliver quality insight. Have topics you'd love us to cover? Share your ideas in the comments or connect with us on social media. Your input guides the future of Pros That Talk. Thanks for being a crucial part of our community. For more Urology insights, Visit Curleez.com, stay tuned and see you next time.

Embed