ACTIVE surveillance is endorsed by most major guidelines as the preferred management option for individuals with low-risk prostate cancer. Despite this, its use remains variable in real-world clinical practice. Furthermore, previous studies characterising active surveillance in this patient population have been restricted to specific insurance carriers or geographic regions. At this year’s American Urological Association (AUA) Annual Meeting, Matthew Cooperberg, University of California San Francisco, California, USA, and colleagues presented results from a study that aimed to overcome the limitations of these extant analyses, and further define trends in the use of active surveillance for prostate cancer across the USA.
Researchers examined data from males with newly diagnosed prostate cancer in the AUA Quality Registry. Between 2014–2019, approximately 84,600 males met the inclusion criteria. The median age of the cohort was 66 years. Active surveillance was characterised by an absence of active treatment and evidence of ongoing monitoring. This was augmented with natural language processing of clinical notes. Overall, 20.3% of patients included in the analysis had low-risk disease at diagnosis. Low-risk prostate cancer was defined by Gleason Grade Group 1, prostate-specific antigen value of less than 10 ng/ml, and missing T stage.
The proportion of patients with low-risk prostate cancer at diagnosis decreased from 24.6% in 2014 to 14.0% in 2019. During the study period, 37.1% and 14.8% of patients with low- and intermediate-risk disease, respectively, chose active surveillance as their primary treatment. No racial or ethnic disparities were observed with regard to the choice of active surveillance. For individuals with low-risk prostate cancer, the rate of active surveillance increased from 29.6% in 2014 to 49.5% in 2019. A similar trend was recorded for those with intermediate-risk disease. In this instance, the rate of active surveillance rose from 10.4% in 2014 and 20.4% in 2019.
In summary, the rates of active surveillance for low- and intermediate-risk prostate cancer increased sharply across the USA from 2014 to 2019. However, the investigators noted that these “are still suboptimal for low-risk disease in particular, and local variation is profound.” Going forward, research should focus on not only improving, but also standardising the uptake and quality of active surveillance.