Dramatic Increase in Active Surveillance Use for Prostate Cancer

A recent study revealed a dramatic increase in the use of active surveillance for prostate cancer, particularly for low- and favorable intermediate-risk cases. Published in JAMA, the research was conducted by Matthew R. Cooperberg, MD, MPH, and colleagues from the University of California San Francisco (UCSF), and examined data from veterans enrolled in the Veterans Affairs Healthcare System (VAHCS).

The study found that active surveillance increased from 27% in 2005 to 93% in 2024 for low-risk prostate cancer and from 14% to 61% for favorable intermediate-risk prostate cancer. The rates varied across individual VA facilities, ranging from 23% to 93%.

Active surveillance is a monitoring approach that allows for the observation of prostate cancer without immediate treatment, with the assumption that the cancer may not progress. Unlike traditional screening methods, active surveillance can prevent unnecessary treatments in cases where the cancer is slow-growing and poses little risk to patients.

According to Cooperberg and colleagues, the findings represent a significant shift in managing low-risk prostate cancer, moving away from overtreatment to a more personalized approach.

Experts like Daniel E. Spratt, MD, of University Hospitals Seidman Cancer Center, noted that the study reflects a paradigm shift in the approach to managing low-risk prostate cancer. Guideline-concordant care is now more focused on individualized treatment plans that minimize unnecessary interventions. The researchers concluded that active surveillance is the preferred management strategy for low-risk and many intermediate-risk prostate cancers, as defined by the National Comprehensive Cancer Network (NCCN) guidelines.