Introduction: Active surveillance (AS) is recommended for the management of favorable-risk prostate cancer (PCa) to avoid the harmful effects of overtreatment. Rates of utilization of AS in the US however remain suboptimal due to multi-factorial issues. We sought to engage a diverse group of patients, patient advocates, researchers and clinicians to better understand the current shortcomings in AS implementation, as well as develop a patient-engaged list of research priorities for PCa AS. Methods: We organized a 2-day conference, Developing Provocative Questions-PCa AS Research Initiative (PCASRI). Through small groups consisting of physicians, patients and families, researchers, and advocates we discussed twelve selected topics in four domains following the PICOTS criteria (Population, Intervention, Outcome, and Setting). Through an iterative process, we generated and then ranked meaningful PCa AS research questions from all participants. Ultimately, eight prioritized questions were selected and ranked through voting. Results: A total of 152 people participated over the 2-day conference with 45.5% patients with PCa, 29.5% urologists, and the remainder a mix of supporters, advocates, and researchers. Eight questions were prioritized out of 22 initially generated. The number one research priority that emerged after this process was “How do we incorporate imaging for improved AS of favorable-risk PCa patients”. The remainder of the 8 research priority topics in order of priority were 2: use of focal therapy to augment AS, 3: risk-specific personalized follow-up intensity for AS, 4: use of telemedicine vs in-person support groups to address disparities in PCa AS utilization, 5: impact of micro-ultrasound vs MRI for AS of PCa, 6: optimal integration of imaging and genomic biomarkers for AS, 7: integration of health educators to improve uptake of AS, and 8: impact of HIIT exercise on PCa AS. Conclusions: We generated a multi-stakeholder engaged process to identify research priorities in improving uptake of AS in the appropriate risk PCa population. The top priority identified was optimal integration of MRI in AS follow-up processes. Continued research in these priority areas combined with continued patient and multi-stakeholder engagement may provide meaningful patient-centered impact on the use of AS. SOURCE OF Funding: This project was funded through a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (EAIN-19842).
