Active Surveillance for Men with Intermediate Risk Prostate Cancer

Area of Science:

• Urology
• Oncology
• Health Services Research

Background:

• Optimal treatment for intermediate-risk prostate cancer is debated, with active surveillance, prostatectomy, and radiotherapy as options.
• While active surveillance is established for low-risk prostate cancer, its application in intermediate-risk cases requires further characterization.
• Understanding trends in active surveillance for intermediate-risk prostate cancer is crucial for guiding treatment decisions.

Purpose of the Study:

• To analyze U.S. national trends in the use of active surveillance for intermediate-risk prostate cancer.
• To identify demographic, clinical, and socioeconomic factors associated with active surveillance in this patient group.

Main Methods:

• Retrospective cohort study of 176,122 men with intermediate-risk prostate cancer (2010-2016) using the National Cancer Database.
• Characterization of temporal trends and factors associated with active surveillance utilization.
• Multivariate analysis to assess predictors of active surveillance.

Main Results:

• Active surveillance use for intermediate-risk prostate cancer nearly tripled from 1.6% in 2010 to 4.6% in 2016.
• Associated factors included older age, recent diagnosis, lower Gleason score/tumor stage, specific insurance types, academic treatment centers, and higher education.
• Race and comorbidities were not significantly associated with active surveillance use.

Conclusions:

• Active surveillance is increasingly used for intermediate-risk prostate cancer, but its adoption reveals clinical and socioeconomic disparities.
• Further research, including prospective data and improved risk stratification, is needed to optimize treatment strategies.
• Addressing disparities in active surveillance access is essential for equitable prostate cancer care.