Active Surveillance Rising for Low-risk and Intermediate-risk Prostate Cancer

While rates of active surveillance for low- and intermediate-risk prostate cancer have substantially increased across the United States since 2014, uptake of active surveillance remains suboptimal for patients with low-risk prostate cancer, according to a study presented by Matthew Cooperberg, MD, of the University of California, San Francisco, at the 2022 American Urological Association Annual Meeting.

The use of active surveillance, while recommended by clinical guidelines for low-risk prostate cancer, is variable in real-world clinical practice and has rapidly evolved in recent years, according to Dr. Cooperberg. Previous research characterizing active surveillance in this population, Dr. Cooperberg added, have been largely limited by their specific geographic locations, and some studies have been “subject to a long lag between diagnosis and data accessibility.”

To overcome these limitations and further define the US rates of active surveillance in prostate cancer, Dr. Cooperberg and colleagues collected data from the AQUA Registry for men with newly diagnosed prostate cancer between 2014 and 2019. A total of 84,596 men in the AQUA registry with a median age of 66 years met the criteria for inclusion in the analysis.

The investigators defined active surveillance based on the lack of active therapy and evidence of ongoing monitoring. This was augmented with natural language processing of physician notes, the researchers explained.

Data were pooled from 1906 urology providers across 206 practices. Approximately 20.3% of patients in the analysis were classified as having low-risk disease at diagnosis, defined by Gleason grade group 1, prostate-specific antigen <10 ng/ml, and missing T stage.

The proportion of patients with low-risk prostate cancer at diagnosis declined from 24.6% in 2014 to 14.0% in 2019. During the study period, 37.1% of patients with low-risk prostate cancer and 14.8% of patients with intermediate-risk disease chose active surveillance as their primary treatment. There were no racial/ethnic differences regarding the choice of active surveillance.

Rates of active surveillance increased over time for patients with low-risk prostate cancer: 29.6% in 2014 to 49.5% in 2019. Additionally, rates of active surveillance in those with intermediate-risk prostate cancer were 10.4% in 2014 to 20.4% in 2019. Although there were noticeable increases in active surveillance for prostate cancer, Dr. Cooperberg and researchers note that the use of active surveillance is still suboptimal in patients with low-risk disease.

At the practice and provider levels, the use of active surveillance in patients with low-risk prostate cancer ranged from 0% to 100%, and provider-level use of active surveillance was associated with practice-level active surveillance use (r=0.65, p<0.01). The researchers noted that there was extensive variation among providers within each practice.