Since 2010, investigators have discovered that the number of patients with prostate cancer in the United States who are choosing active surveillance over surgery or radiation therapy may be rapidly increasing, according to a new study published by Al Awamlh et al in JAMA Internal Medicine.
Background
Active surveillance involves physicians actively monitoring their patients’ prostate cancer for progression with the intention to intervene with surgery or radiation therapy if the cancer progresses.
It may be the preferred treatment approach for patients with low-risk prostate cancer and an option for some patients with favorable intermediate-risk prostate cancer.
Active surveillance may also be capable of mitigating the adverse effects associated with the treatment of prostate cancer, while remaining safe.
“These data show that a diagnosis of prostate cancer no longer means a patient will undergo treatment,” explained senior study author Jonathan Shoag, MD, Associate Professor of Urology at the Case Western Reserve University School of Medicine, Adjunct Clinical Professor of Urology at Weill Cornell Medicine, and a urologist at University Hospitals Cleveland Medical Center. “This further strengthens what are already compelling arguments that the benefits of screening for prostate cancer with [prostate specific antigen tests may] far outweigh the harms. We now can, and do, avoid treating cancers that we believe will behave indolently,” he continued.
Study Methods and Results
In the new study, investigators used the Surveillance, Epidemiology, and End Results program Prostate With Watchful Waiting database to identify patients over 40 years of age who had low- and favorable intermediate-risk prostate adenocarcinoma—and uncovered disparities by race and ethnicity, income, and rurality in receiving active surveillance in the United States between 2010 and 2018.
The investigators found that since 2010, the proportion of patients who elected for active surveillance has increased from 16% to 60% for patients who have low-risk prostate cancer and from 8% to 22% for patients who have favorable intermediate-risk prostate cancer.
Further, the investigators revealed that Hispanic patients, those with low income, and those residing in rural areas were less likely to choose or be offered active surveillance.
Conclusions
“The study's findings are encouraging because it shows an increase in the proportion of [patients] who [may] benefit from active surveillance over time,” emphasized lead study author Bashir Al Hussein Al Awamlh, MD, a second-year Urologic Oncology fellow at Vanderbilt University Medical Center. “Our findings suggest that patients and physicians are increasingly becoming more comfortable with observing a subset of cancers with low-risk features, extending the benefits of [active] surveillance to more [patients]. However, there remains room for improvement in active surveillance uptake to reach similar rates as in some countries in Europe or Australia—particularly in light of recent data demonstrating the safety of active surveillance in low-risk cancers,” he added.
“We would like to see the rising tide of active surveillance lift all boats,” concluded study co-author Daniel Barocas, MD, MPH, FACS, Associate Professor of Urology and Medicine and Executive Vice Chair of the Department of Urology at the Vanderbilt University Medical Center.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
