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Another Look at Trends in Managing Low-Risk Prostate Cancer
Using data from a U.S. urology patient registry, researchers recently documented substantially increasing use of active surveillance (rather than immediate definitive treatment) for men with low-risk prostate cancer, but considerable variability in use was found across urology practices (NEJM JW Gen Med Mar 15 2023 and JAMA Netw Open 2023; 6:231439). Now, investigators have used the U.S. population-based Surveillance, Epidemiology, and End Results database to examine changes in use for active surveillance and watchful waiting (AS/WW) between 2010 and 2018.
During the study period, AS/WW increased from 16% to 60% (for low-risk cancer) and 8% to 22% (for favorable intermediate-risk cancer). Multivariable analyses showed that higher number of positive biopsy cores; lower income; living in rural areas; and Asian, Pacific Islander, or Hispanic ethnicity were associated with lower likelihood of receiving AS/WW. Men in the western U.S. were significantly more likely to receive AS/WW than men in other U.S. regions. Sensitivity analyses showed similar results when only younger men (age, <70) were considered.
These results parallel the other recently published findings cited above: Active surveillance is gaining traction, but substantial variability exists across urology practices and demographic groups. One limitation of the current report is that it lumps together active surveillance (which involves structured monitoring and follow-up) and watchful waiting (which does not). Notably, in a recently published randomized trial, prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active surveillance yielded similar cancer-specific mortality (≈3%) at 15 years in patients with low-risk prostate cancer (NEJM JW Gen Med Apr 1 2023 and N Engl J Med 2023 Mar 11; [e-pub]).
Al Hussein Al Awamlh B et al.
Title: Use of active surveillance vs definitive treatment among men with low- and favorable intermediate-risk prostate cancer in the US between 2010 and 2018.
Source: JAMA Intern Med 2023 Apr 3; [e-pub]. (Abstract/FREE Full Text)