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Updated: Dec 30, 2025
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
The New Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting Database: Opportunities and
Chang Wook Jeong1, Samuel L Washington2, Annika Herlemann3
1Helen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco, CA, USA; Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
Background:
Active surveillance (AS)/watchful waiting (WW) strategy for localized prostate cancer (PCa) is increasingly and broadly endorsed as a preferred option for initial treatment of men with very low- and low-risk PCa, but outcomes can be difficult to analyze in traditional, population-based registries. The recently released Surveillance, Epidemiology, and End Results (SEER) Prostate with WW dataset provides an opportunity to understand national patterns and trends in AS/WW, but the data source itself has not been well described.
Objective:
To provide a comprehensive description of this dataset and investigate possible biases due to missing data.
Design, Setting, And Participants:
The SEER is a population-based epidemiologic registry in the USA. Newly diagnosed PCa patient data were collected from 18 SEER registries between 2010 and 2015, with inclusion of a new treatment variable for AS/WW. We identified 316 724 patients in the entire cohort and 257 060 men with clinically localized PCa (T1-2N0M0).
Intervention:
Various primary treatments for PCa.
Outcome Measurements And Statistical Analysis:
The degree of missing data for each variable was measured. In order to investigate possible bias due to missing data for cancer characterization, we compared two versions of the data: one that excluded cases with missing data and one dataset generated applying multiple imputations.
Results And Limitations:
Only 46% of cases had complete data on basic cancer characteristics for risk stratification. The excluded dataset (N=118 821) differed significantly from the multiple imputation dataset (N=257 060) in the distribution of every reported variable (all p<0.001). The dataset does not distinguish WW from AS, which is a limitation.
Conclusions:
While the SEER Prostate with WW dataset offers a new method to describe treatment trends for men with PCa, including the use of AS/WW, the amount of missing data should not be ignored.
Patient Summary:
While the Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting dataset offers a new method to describe treatment trends for men with prostate cancer, including the use of active surveillance, it has a significant amount of missing data, which can be a source of potential bias if not addressed properly.
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