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Active Surveillance: Path of Choice for Many U.S. Patients With Prostate Cancer

By: Sarah Lynch
Posted: Wednesday, May 3, 2023

Researchers at the Vanderbilt University Medical Center, Nashville, have reported an increase in patients with low- and favorable intermediate–risk prostate adenocarcinoma choosing active surveillance over surgery or radiation therapy. “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,” stated Bashir Al Hussein Al Awamlh, MD, in a Vanderbilt University press release. “However, there remains room for improvement in active surveillance uptake to reach similar rates as in some countries in Europe or Australia, particularly in light of recent data demonstrating the safety of active surveillance in low-risk cancers.” Their study results were published as a research letter in JAMA Internal Medicine.

The team of researchers analyzed data for patients older than age 40 with low- and favorable intermediate–risk prostate adenocarcinoma from 2010 to 2018 using the Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database. They discovered differences in treatment by race and ethnicity, income, and rurality in receiving active surveillance for prostate cancer in the United States. The researchers then used a Cochran-Armitage test and linear regression analysis to analyze temporal trends and changes in treatment ages; they also employed multivariable logistic regression analysis to assess relationships between active surveillance and patient data, as opposed to definitive treatment with radical prostatectomy or radiotherapy.

The researchers determined that the rate of active surveillance increased from 16.4% to 59.9% and from 7.8% to 21.8% in patients with low- and favorable intermediate–risk cancers, respectively. The median age of patients with low-risk cancer undergoing active surveillance decreased by 1 year and by 3 years for patients with intermediate-risk cancer. The researchers also discovered that Hispanic patients, low-income patients, and those residing in rural areas were less likely to have the option of active surveillance.

Disclosure: For full disclosures of the study authors, visit

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