The proportion of men with low-risk prostate cancer managed initially with active surveillance (AS) more than doubled from 2014 to 2021 in the United States, with a concomitant decrease in the use of active treatments, according to data presented at the 2022 American Urological Association (AUA) annual meeting in New Orleans, Louisiana.

Matthew Cooperberg, MD, of the University of California, San Francisco, and colleagues examined data from the AUA Quality (AQUA) Registry, which was launched by the AUA in 2013 to help urology practices understand and improve their quality of care and streamline reporting as mandated by the Centers for Medicare and Medicaid Services. Data are obtained directly from a range of electronic health record systems at participating practices. By mid-2021, the registry included data from 1945 urologists from 349 practices across the United States.

The investigators analyzed data from 20,809 men with low-risk prostate cancer and known primary treatment. The patients had a median age of 65 years at diagnosis. The proportion of men managed with AS rose from 26.5% in 2014 to 59.6% in the first half of 2021, Dr Cooperberg and colleagues reported in a poster presentation. During that same period, the proportion of men treated with radical prostatectomy decreased from 29.7% to 15.8% and the proportion who received external beam radiation therapy decreased from 28.2% to 20.9%.

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The proportion of patients with low-risk prostate cancer managed with AS ranged from 4% to 78% at the practice level and 0% to 100% at the provider level.

Overall, AS rates were not meaningfully different between Black and White patients (39.4% and 39.8%, respectively).

On logistic regression, age, year of diagnosis, and provider volume of low-risk disease were strongly associated with AS receipt, whereas race and practice volume of low-risk disease were not, according to the investigators.

“AS rates are improving but are still suboptimal, and variation across providers is excessive,” the investigators concluded.

They also noted that use of AS for low-risk disease “is a critical quality indicator for urologic oncology.”


Cooperberg M, Meeks W, Fang R, Gaylis F, Catalona W, Makarov D. Active surveillance for low-risk prostate cancer: Time trends and variation in the AUA Quality (AQUA) Registry. Presented at: AUA2022, May 13-16, 2022. Poster MP43-03.