Dr. Claire de la Calle

Then there's how to account for targeted cores.

I really think we tend to overestimate tumor volume in patients with targeted biopsies, especially as, for example, the European guidelines for patients undergoing their first biopsy.

So we're talking about patients with no diagnosis of prostate cancer.

now recommending targeted biopsies only.

You know, providers are now more and more doing that and maybe saturating the area around the target.

That certainly can lead to volume overestimation, or you probably see in your clinic patients that have fusion biopsies and then systematic biopsies, and essentially all the cores in the location of the target are positive as well.

All those nuances, I think, are really important when estimating tumor volume.

And of course, what is the cutoff of pattern four that we're comfortable monitoring?

For grade group two patients, they already have pattern four.

Are we really waiting for grade group three or higher?

So we often call extreme upgrading or extreme grade classification in active surveillance studies.

We know that grade group three patients have

way more, way worse outcomes than grid group two patients.

So I don't know that grid group three is really the outcome we're waiting for, especially those patients.

Not only do they have worse outcomes, like I just said, they also need more intense treatment.

If they have radiation, they're going to potentially need hormonal therapy.

If they undergo surgery or radiation, they might need secondary treatments, salvage treatments.

So those are all also outcomes that we should try to avoid for active surveillance patients that could have treated their cancers earlier on in the timeline of their cancers with potentially less side effects or treatment toxicity.

So that is also very much something that we need to continue looking into and hopefully reach some sort of consensus in our community so that we can better counsel our patients.

Yeah, I certainly, I use the size of the lesion to help me understand if I did good targeting or if a good targeting was done.