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Review of Active Surveillance in Underrepresented and High-Risk Populations: Feasibility and Safety

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Abstract

Purpose of Review

The purpose of this review is to investigate the current use and effectiveness of active surveillance (AS) for clinical low-risk prostate cancer (PCa) in men considered to be “high-risk” based on the factors of race, genetics, healthcare access, and socioeconomic status.

Recent Findings

Advances in molecular biomarkers and imaging have improved the detection, risk stratification, and treatment of PCa. Still, overdiagnosis and overtreatment of indolent disease remain a concern. AS is therefore the preferred option for clinical low-risk disease. Yet, because of the variability in PCa presentation based on the aforementioned environmental and genetic factors, the question remains: Is active surveillance a safe option for everyone?

Summary

Provider hesitancy should not necessarily exclude high-risk men from participating in AS. Rather, clinicians should employ shared decision-making, sound clinical judgment, and stringent follow-up in order to effectively counsel AS candidates and optimize AS-related outcomes in “high-risk” individuals.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin. 2021;71:7.

    Article  PubMed  Google Scholar 

  2. Giaquinto AN, Miller KD, Tossas KY, et al. Cancer statistics for African American/Black People 2022. CA Cancer J Clin. 2022;72:202.

    Article  PubMed  Google Scholar 

  3. Eastham JA, Auffenberg GB, Barocas DA, et al. Clinically localized prostate cancer: AUA/ASTRO guideline, part I: introduction, risk assessment, staging, and risk-based management. J Urol. 2022;208:10.

    Article  PubMed  Google Scholar 

  4. Carroll PH, Mohler JL. NCCN guidelines updates: prostate cancer and prostate cancer early detection. J Natl Compr Canc Netw. 2018;16:620.

    Article  PubMed  Google Scholar 

  5. Eastham James A, Auffenberg Gregory B, Barocas Daniel A, et al. Clinically localized prostate cancer: AUA/ASTRO guideline, part II: principles of active surveillance, principles of surgery, and follow-up. J Urol. 2022;208:19.

    Article  CAS  PubMed  Google Scholar 

  6. Tosoian JJ, Trock BJ, Landis P, et al. Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol. 2011;29:2185.

    Article  PubMed  Google Scholar 

  7. Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33:272.

    Article  PubMed  Google Scholar 

  8. Roobol MJ. Active surveillance for prostate cancer-will the discoveries of the last 5 years change the future? Transl Androl Urol. 2021;10:2828.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ye F, Han X, Shao Y, et al. Identification of novel biomarkers differentially expressed between African-American and Caucasian-American prostate cancer patients. Am J Cancer Res. 2022;12:1660.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Tosoian JJ, Mamawala M, Epstein JI, et al. Active surveillance of grade group 1 prostate cancer: long-term outcomes from a large prospective cohort. Eur Urol. 2020;77:675.

    Article  PubMed  Google Scholar 

  11. Iyengar S, Hall IJ, Sabatino S. Racial/ethnic disparities in prostate cancer incidence, distant stage diagnosis, and mortality by U.S. census region and age group, 2012–2015. Cancer Epidemiol Biomarkers Prev. 2020;29:1357.

  12. Kumar S, Singh R, Malik S, et al. Prostate cancer health disparities: an immuno-biological perspective. Cancer Lett. 2018;414:153.

    Article  CAS  PubMed  Google Scholar 

  13. Hansen M, Hamieh NM, Markt SC, et al. Racial disparities in prostate cancer: evaluation of diet, lifestyle, family history, and screening patterns. Cancer Epidemiol Biomarkers Prev. 2022;31:982.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Defever K, Platz EA, Lopez DS, et al. Differences in the prevalence of modifiable risk and protective factors for prostate cancer by race and ethnicity in the National Health and Nutrition Examination Survey. Cancer Causes Control. 2020;31:851.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Percy-Laurry A, Altekruse SF, Hossain MB, et al. Association between socioeconomic status and tumor grade among black men with prostate cancer. J Natl Med Assoc. 2018;110:53.

    PubMed  Google Scholar 

  16. Rebbeck TR. Prostate cancer disparities by race and ethnicity: from nucleotide to neighborhood. Cold Spring Harb Perspect Med. 2018;8.

  17. • Lowder D, Rizwan K, McColl C, et al. Racial disparities in prostate cancer: a complex interplay between socioeconomic inequities and genomics. Cancer Lett. 531:71, 2022. This article importantly identified and categorized the populations that have the highest incidence and most aggressive subtypes of cancer. The researchers then continue to explain potential explanations for why each of the subpopulation may experience there outcomes.

  18. Berchuck JE, Adib E, Abou Alaiwi S, et al. The prostate cancer androgen receptor cistrome in African American men associates with upregulation of lipid metabolism and immune response. Cancer Res. 2022;82:2848.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gohlke JH, Lloyd SM, Basu S. et al. Methionine-homocysteine pathway in African-American prostate cancer. JNCI Cancer Spectr. 2019;3:pkz019.

  20. Xiao J, Cohen P, Stern MC, et al. Mitochondrial biology and prostate cancer ethnic disparity. Carcinogenesis. 2018;39:1311.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Nair SS, Chakravarty D, Dovey ZS, et al. Why do African-American men face higher risks for lethal prostate cancer? Curr Opin Urol. 2022;32:96.

    Article  PubMed  Google Scholar 

  22. King Thomas J, Mir H, Kapur N, et al. Racial differences in immunological landscape modifiers contributing to disparity in prostate cancer. Cancers (Basel). 2019;11.

  23. Sakiyama MJ, Espinoza I, Reddy A, et al. Race-associated expression of MHC class I polypeptide-related sequence A (MICA) in prostate cancer. Exp Mol Pathol. 2019;108:173.

    Article  CAS  PubMed  Google Scholar 

  24. Elliott B, Zackery DL, Eaton VA, et al. Ethnic differences in TGFβ-signaling pathway may contribute to prostate cancer health disparity. Carcinogenesis. 2018;39:546.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Gillard M, Javier R, Ji Y, et al. Elevation of stromal-derived mediators of inflammation promote prostate cancer progression in African-American men. Cancer Res. 2018;78:6134.

    Article  CAS  PubMed  Google Scholar 

  26. Xu Y, Tsai CW, Chang WS, et al. Epigenome-wide association study of prostate cancer in African Americans identifies DNA methylation biomarkers for aggressive disease. Biomolecules. 2021;11.

  27. Koga Y, Song H, Chalmers ZR, et al. Genomic profiling of prostate cancers from men with African and European ancestry. Clin Cancer Res. 2020;26:4651.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Wang Y, Wang J, Zhang L, et al. RGS12 Is a novel tumor-suppressor gene in African American prostate cancer that represses AKT and MNX1 expression. Cancer Res. 2017;77:4247.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Huang FW, Mosquera JM, Garofalo A, et al. Exome sequencing of African-American prostate cancer reveals loss-of-function ERF mutations. Cancer Discov. 2017;7:973.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Hashimoto Y, Shiina M, Kato T, et al. The role of miR-24 as a race related genetic factor in prostate cancer. Oncotarget. 2017;8:16581.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hashimoto Y, Shiina M, Dasgupta P, et al. Upregulation of miR-130b contributes to risk of poor prognosis and racial disparity in African-American prostate cancer. Cancer Prev Res (Phila). 2019;12:585.

  32. Bree KK, Hensley PJ, Pettaway CA. Germline mutations in African American men with prostate cancer: incidence, implications and diagnostic disparities. Urology. 2022;163:148.

    Article  PubMed  Google Scholar 

  33. Lachance J, Berens AJ, Hansen MEB, et al. Genetic hitchhiking and population bottlenecks contribute to prostate cancer disparities in men of African descent. Cancer Res. 2018;78:2432.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Mavura MY, Huang FW. How cancer risk SNPs may contribute to prostate cancer disparities. Cancer Res. 2021;81:3764.

    Article  CAS  PubMed  Google Scholar 

  35. Wilson BD, Ricks-Santi LJ, Mason TE, et al. Admixture mapping links RACGAP1 regulation to prostate cancer in African Americans. Cancer Genomics Proteomics. 2018;15:185.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Karakas C, Wang C, Deng F, et al. Molecular mechanisms involving prostate cancer racial disparity. Am J Clin Exp Urol. 2017;5:34.

    PubMed  PubMed Central  Google Scholar 

  37. Hur J, Giovannucci E. Racial differences in prostate cancer: does timing of puberty play a role? Br J Cancer. 2020;123:349.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Coughlin SS. A review of social determinants of prostate cancer risk, stage, and survival. Prostate Int. 2020;8:49.

    Article  PubMed  Google Scholar 

  39. Nelson WG, Brawley OW, Isaacs WB, et al. Health inequity drives disease biology to create disparities in prostate cancer outcomes. J Clin Invest. 2022;132.

  40. Yamoah K, Lee KM, Awasthi S, et al. Racial and ethnic disparities in prostate cancer outcomes in the Veterans Affairs Health Care System. JAMA Netw Open. 2022;5: e2144027.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Riaz IB, Islam M, Ikram W, et al. Disparities in the inclusion of racial and ethnic minority groups and older adults in prostate cancer clinical trials: a meta-analysis. JAMA Oncol. 2022.

  42. Balakrishnan AS, Palmer NR, Fergus KB, et al. Minority recruitment trends in phase III prostate cancer clinical trials (2003 to 2014): progress and critical areas for improvement. J Urol. 2019;201:259.

    Article  PubMed  Google Scholar 

  43. Hoge C, Verma S, Lama DJ, et al. Racial disparity in the utilization of multiparametric MRI-ultrasound fusion biopsy for the detection of prostate cancer. Prostate Cancer Prostatic Dis. 2020;23:567.

    Article  PubMed  Google Scholar 

  44. Ahdoot M, Wilbur AR, Reese SE, et al. MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med. 2020;382:917.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378:1767.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hinata N, Fujisawa M. Racial differences in prostate cancer characteristics and cancer-specific mortality: an overview. World J Mens Health. 2022;40:217.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Beebe-Dimmer JL, Zuhlke KA, Johnson AM, et al. Rare germline mutations in African American men diagnosed with early-onset prostate cancer. Prostate. 2018;78:321.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Struewing JP, Hartge P, Wacholder S, et al. The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med. 1997;336:1401.

    Article  CAS  PubMed  Google Scholar 

  49. Conti DV, Wang K, Sheng X, et al. Two novel susceptibility loci for prostate cancer in men of African ancestry. J Natl Cancer Inst. 2017;109.

  50. Loeb S, Catalona WJ. The Prostate Health Index: a new test for the detection of prostate cancer. Ther Adv Urol. 2014;6:74.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Chiu PK, Ng CF, Semjonow A, et al. A multicentre evaluation of the role of the Prostate Health Index (PHI) in regions with differing prevalence of prostate cancer: adjustment of PHI reference ranges is needed for European and Asian settings. Eur Urol. 2019;75:558.

    Article  PubMed  Google Scholar 

  52. Loeb S, Sanda MG, Broyles DL, et al. The prostate health index selectively identifies clinically significant prostate cancer. J Urol. 2015;193:1163.

    Article  PubMed  Google Scholar 

  53. CMS. gov: Biomarker testing for prostate cancer diagnosis. CMS.gov. 2022.

  54. Klein EA, Chait A, Hafron JM, et al. The single-parameter, structure-based IsoPSA assay demonstrates improved diagnostic accuracy for detection of any prostate cancer and high-grade prostate cancer compared to a concentration-based assay of total prostate-specific antigen: a preliminary report. Eur Urol. 2017;72:942.

    Article  PubMed  Google Scholar 

  55. Voigt JD, Dong Y, Linder V, et al. Use of the 4Kscore test to predict the risk of aggressive prostate cancer prior to prostate biopsy: Overall cost savings and improved quality of care to the us healthcare system. Rev Urol. 2017;19:1.

    PubMed  PubMed Central  Google Scholar 

  56. CMS.gov: 4Kscore test algorithm. CMS.gov. 2022

  57. Gaffney CD, Cai P, Li D, et al. Increasing utilization of MRI before prostate biopsy in black and non-black men: an analysis of the SEER-Medicare cohort. AJR Am J Roentgenol. 2021;217:389.

    Article  PubMed  Google Scholar 

  58. Roebuck E, Sha W, Lu CD, et al. Racial and socioeconomic disparities in MRI-fusion biopsy utilization to assess for prostate cancer. Urology. 2022;163:156.

    Article  PubMed  Google Scholar 

  59. Segal N, Ber Y, Benjaminov O, et al. Imaging-based prostate cancer screening among BRCA mutation carriers-results from the first round of screening. Ann Oncol. 2020;31:1545.

    Article  CAS  PubMed  Google Scholar 

  60. Vesprini D. NCT01990521: Screening male BRCA mutation carriers: effectiveness of multispectral 3T magnetic resonance imaging. ClinicalTrials.gov. 2022.

  61. Ajayi A, Rosen MA, Vapiwala N, et al. Disparities in baseline magnetic resonance imaging (MRI) utilization and imaging characteristics for prostate cancer (PCa) patients. J Clin Oncol. 2015;33:119.

    Article  Google Scholar 

  62. Washington C, Goldstein DA, Moore A, et al. Health disparities in prostate cancer and approaches to advance equitable care. Am Soc Clin Oncol Educ Book. 2022;42:1.

    PubMed  Google Scholar 

  63. Lediju O, Ikuemonisan J, Salami SS, et al. Racial disparities in the presentation, early definitive surgical treatment, and mortality among men diagnosed with poorly differentiated/undifferentiated non-metastatic prostate cancer in the USA. J Racial Ethn Health Disparities. 2019;6:401.

    Article  PubMed  Google Scholar 

  64. Bennett CL, Ferreira MR, Davis TC, et al. Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. J Clin Oncol. 1998;16:3101.

    Article  CAS  PubMed  Google Scholar 

  65. Smith ZL, Eggener SE, Murphy AB. African-American prostate cancer disparities. Curr Urol Rep. 2017;18:81.

    Article  PubMed  Google Scholar 

  66. Mahal BA, Chen YW, Muralidhar V, et al. Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States. Ann Oncol. 2017;28:1098.

    Article  CAS  PubMed  Google Scholar 

  67. Iremashvili V, Soloway MS, Rosenberg DL, et al. Clinical and demographic characteristics associated with prostate cancer progression in patients on active surveillance. J Urol. 2012;187:1594.

    Article  PubMed  Google Scholar 

  68. Sundi D, Faisal FA, Trock BJ, et al. Reclassification rates are higher among African American men than Caucasians on active surveillance. Urology. 2015;85:155.

    Article  PubMed  Google Scholar 

  69. Messina C, Cattrini C, Soldato D, et al. BRCA mutations in prostate cancer: prognostic and predictive implications. J Oncol. 2020;2020:4986365.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Castro E, Romero-Laorden N, Del Pozo A, et al. PROREPAIR-B: a prospective cohort study of the impact of germline DNA repair mutations on the outcomes of patients with metastatic castration-resistant prostate cancer. J Clin Oncol. 2019;37:490.

    Article  CAS  PubMed  Google Scholar 

  71. Kelly BD, Perera M, Bolton DM, et al. Social determinants of health: does socioeconomic status affect access to staging imaging for men with prostate cancer. Prostate Cancer and Prostatic Dis. 2022.

  72. Du XL, Fang S, Coker AL, et al. Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer. 2006;106:1276.

    Article  PubMed  Google Scholar 

  73. • Mahal BA, Butler S, Franco I, et al. Use of active surveillance or watchful waiting for low-risk prostate cancer and management trends across risk groups in the United States, 2010–2015. Jama. 321:704. This article aided in identifying the use of active surveillance in the populations that we were interested in while preforming this review. This allowed us to determine how prevalent the use of active surveillance was in our groups of interest.

  74. Liu JL, Patel HD, Haney NM, et al. Advances in the selection of patients with prostate cancer for active surveillance. Nat Rev Urol. 2021;18:197.

    Article  PubMed  Google Scholar 

  75. Komisarenko M, Martin LJ, Finelli A. Active surveillance review: contemporary selection criteria, follow-up, compliance and outcomes. Transl Androl Urol. 2018;7:243.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol. 2015;33:3379.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Newcomb LF, Brooks JD, Carroll PR, et al. Canary Prostate Active Surveillance Study: design of a multi-institutional active surveillance cohort and biorepository. Urology. 2010;75:407.

    Article  PubMed  Google Scholar 

  78. Bokhorst LP, Valdagni R, Rannikko A, et al. A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment. Eur Urol. 2016;70:954.

    Article  PubMed  Google Scholar 

  79. Carlsson S, Benfante N, Alvim R, et al. Long-term outcomes of active surveillance for prostate cancer: the Memorial Sloan Kettering Cancer Center experience. J Urol. 2020;203:1122.

    Article  PubMed  Google Scholar 

  80. Klotz L, Zhang L, Lam A, et al. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol. 2010;28:126.

    Article  PubMed  Google Scholar 

  81. Iremashvili V, Pelaez L, Manoharan M, et al. Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur Urol. 2012;62:462.

    Article  PubMed  Google Scholar 

  82. Butler S, Muralidhar V, Chavez J, et al. Active surveillance for low-risk prostate cancer in black patients. N Engl J Med. 2019;380:2070.

    Article  PubMed  PubMed Central  Google Scholar 

  83. •• Odom BD, Mir MC, Hughes S, et al. Active surveillance for low-risk prostate cancer in African American men: a multi-institutional experience. Urology. 2014;83:364. This article was very important to our paper because it investigated one of the largest at risk populations for the development of PCa and looked at the outcomes after being “treated” with active surveillance.

  84. Chornokur G, Dalton K, Borysova ME, et al. Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer. Prostate. 2011;71:985.

    Article  PubMed  Google Scholar 

  85. Barocas DA, Grubb R 3rd, Black A, et al. Association between race and follow-up diagnostic care after a positive prostate cancer screening test in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer. 2013;119:2223.

    Article  PubMed  Google Scholar 

  86. Schenk JM, Newcomb LF, Zheng Y, et al. African American race is not associated with risk of reclassification during active surveillance: results from the Canary Prostate Cancer Active Surveillance Study. J Urol. 2020;203:727.

    Article  PubMed  Google Scholar 

  87. Davis JW, Ward JF 3rd, Pettaway CA, et al. Disease reclassification risk with stringent criteria and frequent monitoring in men with favourable-risk prostate cancer undergoing active surveillance. BJU Int. 2016;118:68.

    Article  PubMed  Google Scholar 

  88. Greenberg JW, Leinwand G, Feibus AH, et al. Prospective observational study of a racially diverse group of men on active surveillance for prostate cancer. Urology. 2021;148:203.

    Article  PubMed  Google Scholar 

  89. Labagnara K. Zhu D, Loloi J, et al. Low risk is low risk, regardless of race or ethnicity: outcomes of prostate cancer active surveillance and factors associated with reclassification in a racially diverse cohort. Urol Oncol. 2023.

  90. Vigneswaran HT, Mittelstaedt L, Crippa A, et al. Progression on active surveillance for prostate cancer in Black men: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2022;25:165.

    Article  PubMed  Google Scholar 

  91. Bjurlin MA, Mendhiratta N, Wysock JS, et al. Multiparametric MRI and targeted prostate biopsy: improvements in cancer detection, localization, and risk assessment. Cent European J Urol. 2016;69:9.

    CAS  PubMed  PubMed Central  Google Scholar 

  92. Bloom JB, Lebastchi AH, Gold SA, et al. Use of multiparametric magnetic resonance imaging and fusion-guided biopsies to properly select and follow African-American men on active surveillance. BJU Int. 2019;124:768.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Castro E, Goh C, Olmos D, et al. Germline BRCA mutations are associated with higher risk of nodal involvement, distant metastasis, and poor survival outcomes in prostate cancer. J Clin Oncol. 2013;31:1748.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Carter HB, Helfand B, Mamawala M, et al. Germline mutations in ATM and BRCA1/2 are associated with grade reclassification in men on active surveillance for prostate cancer. Eur Urol. 2019;75:743.

    Article  CAS  PubMed  Google Scholar 

  95. Taylor RA, Fraser M, Rebello RJ, et al. The influence of BRCA2 mutation on localized prostate cancer. Nat Rev Urol. 2019;16:281.

    Article  PubMed  Google Scholar 

  96. Halstuch D, Ber Y, Margel D. Screening, active surveillance, and treatment of localized prostate cancer among carriers of germline BRCA mutations. Eur Urol Focus. 2020;6:212.

    Article  PubMed  Google Scholar 

  97. Halstuch D, Ber Y, Kedar D, et al. Short-term outcomes of active surveillance for low risk prostate cancer among men with germline DNA repair gene mutations. J Urol. 2020;204:707.

    Article  PubMed  Google Scholar 

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  1. Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, 07103, USA

    John Fastenau, Kunj Jain, Aleksandar Popovic & Evan Kovac

  2. Cancer Institute of New Jersey, Newark, NJ, USA

    Evan Kovac

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  1. John Fastenau
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Fastenau, J., Jain, K., Popovic, A. et al. Review of Active Surveillance in Underrepresented and High-Risk Populations: Feasibility and Safety. Curr Urol Rep 24, 307–315 (2023). https://doi.org/10.1007/s11934-023-01158-5

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