Factors Influencing Selection of Active Surveillance for Low-Risk Prostate Cancer

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Investigators may have uncovered some of the factors associated with the selection of active surveillance over surgery or radiation therapy in patients with low-risk prostate cancer, according to a recent study published by Xu et al in Cancer.


Guidelines for low-risk prostate cancer that is unlikely to spread or impact survival often recommend active surveillance—which involves regular monitoring to delay or avoid surgery or radiation therapy and potentially life-changing complications.

Study Methods and Results

In the recent Treatment Options in Prostate Cancer Study, the investigators analyzed the self-reported patient data from metro-Detroit and Georgia cancer registries involving 1,688 Black and White patients newly diagnosed with low-risk prostate cancer from 2014 to 2017.

The investigators discovered that 57% of the patients chose active surveillance—including 51% of the Black patients and 61% of the White patients—compared with other treatment options. After adjusting for other influencing factors, the strongest determinant of active surveillance uptake was a urologist’s recommendation. Further, factors such as shared patient-physician treatment decisions and greater knowledge of prostate cancer were linked to the selection of active surveillance. The investigators reported that the patients who resided in metro-Detroit seemed to b more likely to select active surveillance than those residing in Georgia. Conversely, the patients were less likely to choose active surveillance if their considerations were strongly influenced by the desire to achieve a cure, if they expected to live longer with treatment, or if they perceived their low-risk prostate cancer diagnosis as more serious.


The investigators underscored that education and interventions addressing these factors may increase the use of recommended active surveillance among patients with low-risk prostate cancer and urologists.

“I am glad to see that the majority of our study participants selected active surveillance, which indicates that acceptance has improved over the last decade; however, there is room for greater acceptance. Our study findings shed new light on potentially modifiable factors that can help further increase active surveillance use among patients with newly diagnosed low-risk prostate cancer to avoid unnecessary invasive treatment and improve their quality of life,” concluded lead study author Jinping Xu, MD, MS, of Wayne State University.

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