Active Surveillance for Low-, Intermediate-Risk Prostate Cancer on the Rise

WEDNESDAY, April 5, 2023 (HealthDay News) -- Use of active surveillance (AS) increased to approximately 60 percent for low-risk and 20 percent for favorable intermediate-risk prostate cancer from 2010 to 2018, according to a research letter published online April 3 in JAMA Internal Medicine.

Bashir Al Hussein Al Awamlh, M.D., from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues used data from the Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting (WW) database to assess AS use and variables associated with it from 2010 to 2018. The analysis included men aged 40 years and older with low- and favorable intermediate-risk prostate adenocarcinoma.

The researchers found that the rate of AS/WW use increased from 16.4 to 59.9 percent in patients with low-risk cancer and from 7.8 to 21.8 percent in patients with favorable intermediate-risk cancers during the study period. There was a decrease observed in the median age of men who underwent AS/WW for low-risk prostate cancer (from 65 to 64 years; mean annual change, −0.15 year) and for favorable intermediate-risk prostate cancer (from 70 to 67 years; mean annual change, −0.20 year). Higher income was associated with choosing AS/WW, while the number of positive biopsy cores was associated with increased odds of undergoing definitive treatment (adjusted odds ratio, 0.56 for two positive biopsy cores in low-risk disease). AS/WW was less likely among Asian/Pacific Islander and Hispanic men versus White men. Additionally, rurality was associated with definitive treatment for low-risk disease. Similar results were seen for men aged 70 years or younger.

"Our findings suggest that patients and physicians are increasingly becoming more comfortable with observing a subset of cancers with low-risk features, extending the benefits of surveillance to more men," Al Awamlh said in a statement.

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