Active Surveillance for Very Low-Risk Prostate Cancer Is Still Underutilized

Active Surveillance for Very Low-Risk Prostate Cancer Is Still Underutilized

While patients with very low-risk prostate cancer may be treated with active surveillance (AS), reducing over-treatment and treatment-related complications, a new study shows that only one in four patients in this group actually opt for this treatment. Despite this low figure, however, the use of AS has nearly tripled from 2010 to 2013.

The study, “Trends in active surveillance for very low-risk prostate cancer: do guidelines influence modern practice?“, was published in the journal Cancer Medicine.

AS is used in patients with localized, favorable/low-risk prostate cancer. It was developed to reduce the risks associated with over-diagnosis and over-treatment. It also aims to provide treatment for patients with localized cancers that are likely to progress and to reduce the complications resulting from treatment of cancers that are not likely to progress.

Despite National Comprehensive Cancer Network (NCCN) guidelines recommending the use of AS, data to evaluate trends of its use in patients with very low-risk prostate cancer in the U.S. are still limited. Therefore, researchers aimed to examine the trends in adherence to national guidelines regarding AS.

The authors used data from the National Cancer Database (NCDB) from 2010 to 2013. They found that of 448,773 patients diagnosed with prostate cancer, 40,838 had very low-risk prostate cancer. Only 5,798, or 14.2%, were prescribed AS. But the rates had increased from 11.6% in 2010 to 27.3% in 2013.

Patients without insurance had a higher chance of receiving AS compared with those who had insurance (22.1% vs. 16%). Recent analysis has shown that AS can provide significant savings on the cost of treatment compared to curative intervention treatments ($7,298 vs. $23,565 ).

Patients diagnosed at community cancer programs or academic and research facilities were more likely to receive AS than those diagnosed at comprehensive or integrative centers (86% vs. 90%). This may be because AS programs involve the expertise of a multidisciplinary team including medical oncologists, urologists, and radiation oncologists.

Patients over the age of 62 were more likely to undergo AS than those under 62 years of age, and patients who lived farther away from medical facilities were less likely to get AS treatment compared to those who lived closer.

The authors comment that “given the multiple clinical and nonclinical factors that appear to determine the patient’s road to AS or active intervention, we suggest that multidisciplinary teams should continue to offer a comprehensive and accurate clinical program incorporating AS that abides by national guidelines and is reassuring to their patients.”

They favor the use of AS and conclude by saying, “the current low, but rising rates of AS and the apparent disparities in its prescription, may be an opportunity for the medical community to improve the quality of life of our patients [by avoiding harm from unnecessary treatment] while subsequently reducing the financial burden on the healthcare system.”