key: cord-1044194-1d5ymjqh authors: Davis, John W. title: Eye of the beholder—Tales from Prostate Cancer Active Surveillance Development date: 2021-03-27 journal: BJUI Compass DOI: 10.1002/bco2.80 sha: 7709aa0bafdcb835d0d08ebdc1968aac761577d3 doc_id: 1044194 cord_uid: 1d5ymjqh nan when it was a smaller research-oriented retreat. We had back-toback speakers on prostate cancer with different messages that had a bit of humorously conflicting conclusions. The first speaker was Andrew Vickers from Memorial Sloan Kettering Cancer Center, 1 presenting on the learning curve of radical prostatectomy. At the end of that lecture, everyone was probably thinking to themselves: "Oh no, I need to go home and double my radical prostatectomy case volumes, or I might be labelled as a low volume surgeon." The next speaker was Lawrence Klotz from the University of Toronto 2 who presented his maturing data and successes with active surveillance for low-risk prostate cancer. At the end of that lecture, everyone was probably thinking to themselves: "Oh no, I need to go home and cut my radical prostatectomy volumes in half, or I might be labelled as an over-treating/patient-harming surgeon." This era of active surveillance data was a breakthrough in the field-previous presentations of less mature data were often attacked for being dangerous and risking pT3 cancer progression. This lecture was one of the early ones that was mature enough to be convincing that low-risk prostate cancer was a different entity. Of course, by 2021, we now have strong guidance on the surveillance management of low-risk prostate cancer and can focus treatments more on intermediate to high-risk patients. In support of Dr Vickers findings, we have trended towards more surgical subspecialization and higher case volumes to improve quality of results. In this same area of case selection and referrals, however, there are low and favourable-intermediate risk patients who are appropriate candidates for active surveillance, but can be predicted to be at high risk of progression and need for future treatment. These patients are an interesting group to talk with, as when you spell out the choices and bigger picture, you often get patients gravitating towards one of the two ways of thinking about it: (1) treat it now at a lower risk/ volume category with higher cure rate chances and a young age to make a good functional recovery, and (2) take advantage of the next 3-5 years on active surveillance free of treatment-related side effects. There is no right or wrong approach here. The dilemma is sort of a "pay it now or pay it later" situation, but I have also used the phrase "beauty is in the eye of the beholder," to illustrate the point that some active surveillance vs treatment decisions are subjective, and patients may look at the value of each strategy differently. For another bit of a rabbit trail diversion, the phrase "beauty is in the eye of the beholder" is credited to an author Margaret Wolfe The surgical learning curve for prostate cancer control after radical prostatectomy Active surveillance for prostate cancer: for whom? Digital ethnographic analysis of prostate cancer discussions on social media Cost-effectiveness of hydrophilic-coated urinary catheters for individuals with spinal cord injury: a systematic review The impact of age on prostate cancer progression and quality of life in active surveillance patients What is the best way to manage ureteric calculi in the time of COVID-19? A comparison of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in an Australian health-care setting Safety of "hot" and "cold" site admissions within a high-volume urology department in the United Kingdom at the peak of the COVID-19 pandemic Survey on ureTEric draiNage post uncompli-caTed ureteroscopy (STENT). BJUI Compass A novel prognostic model for Japanese patients with newly diagnosed bone-metastatic hormone-naïve prostate cancer A multi-institutional randomized controlled trial comparing first-generation transrectal high-resolution micro-ultrasound with conventional frequency transrectal ultrasound for prostate biopsy U R E 5 The bald eagles fly and fish in the protected areas of the Alaskan Inside Passage