More patients undergoing active surveillance for lower-risk prostate cancers

Use of active surveillance or watchful waiting for prostate cancer rose significantly in recent years, a study found.

The study used deidentified data from the Surveillance, Epidemiology and End Results Prostate with Watchful Waiting database on men older than age 40 years diagnosed from 2010 to 2018 with low- and favorable intermediate-risk prostate adenocarcinoma. While the database distinguishes between active surveillance or watchful waiting, in which clinicians do not monitor cancer for progression but observe patients until it becomes symptomatic, the study combined these categories. Results were published as a research letter on April 3 in JAMA Internal Medicine.

Over the study period, rates of active surveillance or watchful waiting increased from 16.4% to 59.9% in patients with low-risk cancers and from 7.8% to 21.8% in those with favorable intermediate-risk cancers (P<0.001 for both). The median age of men who underwent either process decreased both for low-risk cancer (from 65 to 64 years; mean annual change, −0.15 year; P<0.001) and for favorable intermediate-risk cancer (from 70 to 67 years; mean annual change, −0.20 year; P<0.001).

The number of positive biopsy cores was associated with increased odds of undergoing definitive treatment (adjusted odds ratio, 0.56; 95% CI, 0.53 to 0.58 for two positive biopsy cores in low-risk disease). Asian/Pacific Islander and Hispanic men were less likely to undergo watchful waiting or active surveillance compared with White men, and rural populations were more likely to receive definitive treatment for low-risk disease. Men with higher incomes were more likely to choose active surveillance or watchful waiting.

Despite these increases in active surveillance and watchful waiting, the U.S. trails Sweden (74% by 2014) and Australia (67% by 2016) in its use, the study authors said. In addition, two positive cores were associated with an almost 50% decrease in active surveillance, even though it's not clear whether a second positive core should have such an impact, they wrote. “This is worrisome, particularly with the increasing use of magnetic resonance imaging in biopsy, which may bias toward more positive cores and potentially higher rates of downgrading at prostatectomy.”