Use of active surveillance (AS) for low-risk localized prostate cancer (PCa) rose dramatically from 2004 to 2015 in the United States, new data suggest.

An analysis of data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database showed that the use of AS for men with Gleason score 6 or less PCa increased from 24% of cases in 2004-2005 to 53% of cases in 2014-2015, a team led by David H. Howard, PhD, of Emory University in Atlanta, Georgia, reported in Urologic Oncology. The increase varied by age group, with AS use increasing from 18% to 50% of patients aged 66 to 74 years and from 32% to 61% of those aged 75 years or older.

From 2004-2005 to 2014-2015, the proportion of men with Gleason score 7 or higher placed on AS increased from 9% to 12% overall. The proportion rose from 6% to 10% among men aged 66 to 74 years and from 13% to 15% among those aged 75 years or older.

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In addition, among men with Gleason score 6 or less cancer, non-Hispanic Black (NHB) men were less likely to undergo AS compared with non-Hispanic White (NHW) men, according to the investigators. In 2014-2015, 42% of NHB patients underwent AS compared with 55% of NHW patients.

The study also revealed a large increase in the proportion of men with Gleason score 7 or higher who underwent intensity-modulated radiation therapy: from 16% in 2004-2005 to 34% in 2014-2015.

Among men diagnosed with Gleason score 7 or higher disease in 2014-2015, a greater proportion of NHW than NHB patients underwent radical prostatectomy (24% vs 16%), according to investigators.

“A large proportion of men, especially NHB men, did not undergo active treatment or active surveillance,” the authors concluded. “It is unclear if the lack of treatment and surveillance was consistent with their preferences or reflects a lack of comfort seeking medical care, inadequate communication by clinicians, or transportation difficulties.”

The study included 178,297 patients, of whom 73,435 had a Gleason score 6 or less and 104,862 had a Gleason score of 7 or higher.


Liu Y, Hall IJ, Filson C, Howard DH. Trends in the use of active surveillance and treatments in Medicare beneficiaries diagnosed with localized prostate cancer. Published online December 9, 2020. Urol Oncol. doi:10.1016/j.urolonc.2020.11.024