Use of active surveillance (AS) and watchful waiting (WW) for low-risk prostate cancer (PCa) increased from 2010 to 2015 in the United States.
To determine contemporary national trends, Brandon A. Mahal, MD, of the Dana-Farber Cancer Institute in Boston, and colleagues queried the Surveillance, Epidemiology, and End Results (SEER) Prostate AS/WW database. Of 164,760 men with localized PCa, 20,879 (12.7%) received AS/WW, 68,350 (41.5%) radiation therapy (RT), and 75,531 (45.8%) radical prostatectomy (RP) during the 5-year period.
According to an online report in JAMA, significantly fewer men were diagnosed with low-risk disease in 2015 than in 2010 (24.5% vs 34.2%) and at significantly older ages (median 65 vs 64 years) and with significantly higher PSA (median 6.7 vs 6.0 ng/mL). For the 50,302 men with low-risk disease, AS/WW increased from 14.5% in 2010 to 42.1% in 2015. Concurrently, RP significantly decreased from 47.4% to 31.3% and RT from 38.0% to 26.6%.
For the 81,836 men with intermediate-risk PCa, AS/WW significantly increased from 5.8% to 9.6% over the period. Meanwhile, RP significantly decreased from 51.8% to 50.6% and RT from 42.4% to 39.8%.
The investigators observed concerning trends in the 32,622 patients with high-risk disease. Low AS/WW use endured from 1.9% in 2010 to 2.2% in 2015. But RP spiked significantly from 38.0% to 42.8%, whereas RT declined from 60.1% to 55.0%.
“Although increasing use of AS/WW for low-risk disease has been supported by high-level evidence and guidelines since 2010, shifting management patterns toward more radical prostatectomy in higher risk disease and away from radiotherapy does not coincide with any new level 1 evidence or guideline changes,” according to Dr Mahal and the team.
Mahal BA, Butler S, Franco I, et al. Use of active surveillance or watchful waiting for low-risk prostate cancer and management trends across risk groups in the United States, 2010-2015. JAMA (Published online February 11, 2019). DOI:10.1001/jama.2018.19941