The use of active surveillance and watchful waiting significantly increased in patients with intermediate-risk prostate cancer between 2010 and 2020, according to a recent study published in JAMA, findings that underscore cancer grade as a key factor in selecting initial management for prostate cancer.  

William Catalona, MD, professor of Urology, was a co-author of the study. 

Prostate cancer is the second-leading cause of death in men in the U.S., according to the Centers for Disease Control and Prevention, and men who are older and are African American have an increased risk of developing prostate cancer.  

Current prostate cancer risk stratification tools, such as active surveillance and watchful waiting, are commonly used to determine treatment plans in patients with low-risk prostate cancer but have not yet fully been studied in patients with intermediate-risk prostate cancer. Therefore, better methods of predicting the potential aggressiveness of prostate cancer in patients are urgently needed, according to Catalona.  

“Active surveillance amounts to delaying or avoiding radical treatment while monitoring the patient with prostate examinations, PSA blood tests at approximately six-month intervals, and performing surveillance prostate biopsies or MRI scans at 1 to two-year intervals, with conversion to active treatment if there is evidence of cancer progression, usually determined by higher-grade or more extensive cancer found on the surveillance biopsies. Surveillance testing intervals may be lengthened after previous checks have shown no evidence of progression over several years, and, as the patient’s natural life expectancy decreases with time, ‘active surveillance with curative intent’ often transitions to ‘watchful waiting’ without further scheduled testing and no plans for radical treatment,” said Catalona, who is also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. 

In the current study, Catalona and his team examined patient data of more than 147,000 individuals with intermediate-risk prostate cancer diagnosed during the years 2010 through 2020 from the Surveillance, Epidemiology, and End-Results (SEER) prostate cancer database.  

Using this data, they examined linear time trends in the use of active surveillance and watchful waiting as defined in SEER based on record review, including mention of intentional observation of prostate cancer.  

From their analysis, they found that the proportion of individuals diagnosed with intermediate-risk prostate cancer increased from 41.7 percent in 2010 to 47.3 percent in 2020, and active surveillance and watchful waiting use increased from 5 percent in 2010 to 12.3 percent in 2020.  

Additionally, active surveillance and watchful waiting use increased from 13.2 percent in 2010 to 53.8 percent in 2020 in intermediate-risk patients with grade 1 cancers and from 4 percent to 11.6 percent in patients with grade 2 cancer.  

In intermediate-risk patients with grade 3 cancer, however, active surveillance and watchful waiting only increased from 2.5 percent in 2010 to 2.8 percent in 2020. Hispanic individuals were also less likely to adopt active surveillance or watchful waiting for intermediate-risk prostate cancer, according to the study.  

Moving forward, Catalona said his team aims to further define and improve the adoption, quality, equity, and outcomes of active surveillance on a national and global scale, as well as identify the best strategies for selecting and managing patients with favorable-risk prostate cancer. 

“Together, our results will be impactful for patients with favorable-risk prostate cancer, with the potential to substantially improve the quality of care for prostate cancer, and the lives of patients with prostate cancer and their families,” Catalona said.  

This work was supported by the Urological Research Foundation.