Rising Active Surveillance/Observation Rates and Regimen Intensification in Young Men: A Retrospective Cohort Study...

To analyze active surveillance/observation (AS/O) trends, treatment selection, treatment-free survival, and surveillance regimen intensity in men ≤65 using a national commercial health insurance claims database.

We retrospectively reviewed the Merative Marketscan Commercial Database for localized prostate cancer among men ≤65 years between 2004 and 2023. Each had a newly-diagnosed prostate cancer, a biopsy <180 days before diagnosis, and ≥2 evaluation and management visits for prostate cancer. The primary outcomes were treatment selection and health services claims after diagnosis. Descriptive statistics and Kaplan-Meier analyses are reported.

We identified 29,484 men ≤65 years with localized prostate cancer, with median age 58.0 years (IQR 55.0-61.0). AS/O increased from 10.4% to 35.1%, while prostatectomy decreased from 55.5% to 42.8%. Overall, 5861 (19.9%) men underwent AS/O in the first year after diagnosis; 4561 (77.8%) remained on AS/O. After 1 year of AS/O, treatment-free survival rates at 2-, 3-, and 5-years were 86.1% (95%CI:85.1%-87.0%), 79.0% (77.8%-80.2%), and 68.8% (67.1%-70.4%), respectively. In the first 2 years of AS/O, men who had a urologist visit rose from 88.5% to 91.1%, biopsy from 18.0% to 48.9%, MRI from 0.0% to 63.7%, and PSA from 59.0% to 97.0%.

Younger men have increased adoption of AS/O and intensified AS/O regimens over time. These shifting treatment patterns could be due to improved guideline implementation or acceptance of AS/O to preserve functional status.