Prostate Cancer Active Surveillance Increasing, But Still Low

09/27/17

Use of active surveillance for very low-risk prostate cancer rose 15.7% over a 3-year span and continues to rise, but rates are still low.

National Comprehensive Cancer Network (NCCN) guidelines suggest active surveillance for most men with very low-risk prostate cancer. However, a growing wealth of data suggests that active surveillance is underutilized in this patient population.

Rahul R Parikh, MD, Rutgers Cancer Institute (New Brunswick, NJ), and colleagues conducted a study to analyze trends in active surveillance use among patients with low-risk prostate cancer. Researchers identified men with biopsy-supported very low-risk disease that met active surveillance criteria as defined by Epstein criteria (stage T1c or less disease, Gleason score of 6 or less, PSA less than 10 ng/mL, and 2 or fewer [or less than 33%] positive biopsy cores). A total of 40,838 patients met this criteria from the National Cancer Data Base from 2010-2013.

Results of the study were published in Cancer Medicine (online September 18, 2017; doi:10.1002/cam4.1132).

Researchers reported that only 14.2% of the patient sample were managed with active surveillance (n = 5798). Among those who opted for treatment, 52.2% underwent radical prostatectomy.

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However, researchers noted a trend of increasing use of active surveillance over the 3-year span. The proportion of patients placed on active surveillance increased from 11.6% in 2010 to 27.3% in 2013.

Multivariable analysis showed that older patients and those without insurance were more likely to be managed with active surveillance than younger patients and those with insurance. Additionally, the analysis revealed that patients were more likely to be placed on active surveillance if they received care at an academic or research center rather than another type of facility.

“With concerns of over-diagnosis and over-treatment of prostate cancer, the current national guidelines suggest that patients who meet appropriate criteria should undergo active surveillance with conversion to curative treatment at evidence of progression,” researchers wrote. “Disparities in the use of active surveillance may be targeted to improve adherence to national guidelines.”—Zachary Bessette