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A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
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More Judicious Use of Expectant Management for Localized Prostate Cancer during the Last 2 Decades
J B Eifler1, J Alvarez2, T Koyama2
1Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
The Journal of Urology
|December 17, 2016
Summary
Expectant management for prostate cancer has evolved, with active surveillance becoming more aligned with disease risk over two decades. Older men were more likely to be observed, but comorbidities had little influence.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- Urologists face criticism for overtreatment of low-risk prostate cancer and undertreatment of high-risk disease.
- Active surveillance (AS) and watchful waiting (WW) are observation strategies for localized prostate cancer.
- There's a need to understand the evolution of expectant management strategies over time.
Purpose of the Study:
- To compare expectant management trends in two population-based cohorts over two decades.
- To determine how disease risk, age, and comorbidities influenced the use of definitive treatment versus expectant management.
- To assess the evolution of active surveillance and watchful waiting in localized prostate cancer care.
Main Methods:
- Comparison of two population-based cohorts: Prostate Cancer Outcomes Study (PCOS) and Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR).
- Analysis of 5,871 men with localized prostate cancer.
- Focus on the utilization of definitive treatment versus expectant management (WW or AS) based on disease risk, age, and comorbidities.
Main Results:
- Use of WW or AS was similar in PCOS and CEASAR (14% each).
- CEASAR showed increased WW/AS for low-risk disease (25% vs. 15% in PCOS) but decreased use for intermediate and high-risk disease.
- Disease risk significantly influenced WW/AS in CEASAR (OR 7.3) compared to PCOS; older age was associated with WW/AS, but comorbidities were not.
Conclusions:
- Expectant management, particularly active surveillance, is now more aligned with prostate cancer risk in recent cohorts.
- A shift from watchful waiting to active surveillance is suggested by the data.
- While older age correlates with observation, comorbidities play a minimal role in this decision.
