Receiving the AUA Summer Student Fellowship has helped me greatly to advance my career as a medical student interested in prostate cancer research and urologic oncology. I wish to thank the New England Section of the AUA; my primary mentor at the Yale School of Medicine, Dr Michael Leapman; members of the Yale Urology Department led by Dr Isaac Kim; and the Urology Care Foundation™. With a passion for urologic research, I have grown so much as a scholar with the generous support of this award and through the patient mentorship of my accomplished mentors. The AUA Summer Medical Student Fellowship has been personally and professional rewarding, allowing me to connect with urologists across the US to learn more about their disciplines while advancing research on active surveillance for prostate cancer.

My research aims to qualitatively understand ways to improve the clinical management of low- and intermediate-risk prostate cancer using active surveillance. This project aims to outline communication strategies to improve patient-provider communication about risk assessment technologies. Understanding the adoption and impact of new risk assessment technologies like prostate MRI and genomic testing in prostate cancer care is essential to improve diagnoses, reduce barriers to care and unnecessary treatment, improve patient-provider communication, and better inform patients of the risks and benefits of pursuing active surveillance over more traditional treatment options.

As a consequence of early detection practices, a substantial percentage of diagnosed cancers have indolent or low-risk features and will not benefit from immediate treatment. Active surveillance, or close monitoring of the disease, is now the recommended approach for patients with low-risk prostate cancer; however, this approach remains underutilized in the US. Tools that provide greater information about prostate cancer behavior and clinical risks have been seen as valuable in guiding initial decision making about active surveillance or initial treatment.

Prostate MRI and tissue-based gene expression testing (“genomic testing”) can improve the diagnosis and local staging of prostate cancer in patients with localized prostate cancer. However, due to the relative novelty of these technologies, providers often cite uncertainty in interpreting risk estimates, unfamiliarity with available risk assessment technologies, or discomfort when utilizing them to counsel patients about treatment or surveillance options, particularly when discrepancies emerge between tests. Prior qualitative studies from our group focusing on patients with prostate cancer have uncovered key needs relating to physician communication of testing results and their implications for clinical care. Interviews with patients revealed that they highly value prostate MRI and genomic testing as components of active surveillance but raised concerns about the adequacy of provider explanations and highlighted patient uncertainty about the specific role of these tests in longitudinal follow-up. Few studies have qualitatively investigated provider experiences utilizing prostate MRI or genomic testing as active surveillance tools. Gaining an improved understanding of provider perspectives on these tools and the barriers and facilitators to their utilization is important to improve resource utilization, provider education, patient communication, and testing effectiveness.

Overall, this study aims to fill in critical gaps in clinical knowledge surrounding patient-provider communication of prostate MRI and to better understand provider experience with and confidence in utilizing prostate MRI and genomic testing as diagnostic tools. Furthermore, we hope that these results will be immediately clinically relevant by helping improve risk assessment tools and the ways these tests are explained to patients; optimizing patient experience, education, and counseling; and enhancing the quality of monitoring during active surveillance, helping to inform future investigations and outline suggestions for developing standardized communication tools. Improvements to the ways that these risk-assessment technologies are selected and utilized in clinical settings, and understanding the barriers and facilitators to their use, is essential to improving patient outcomes, enhancing monitoring quality during active surveillance, and informing the development of new diagnostic guidelines to improve understanding of genomic testing.

AUA Summer Fellowship link: https://www.auanet.org/research-and-data/research-awards/aua-funding/summer-medical-student-fellowships/2023-summer-medical-student-fellows