The use of active surveillance for prostate cancer is increasing among younger, privately insured men, according to findings of a study presented at the AUA annual meeting in San Francisco.
The research, however, raises concern about the quality of the care provided, said first author Simon P. Kim, MD, MPH.
Using a large commercial insurance database including privately insured patients and Medicare Advantage enrollees (Optum Labs), the study identified 27,812 men ages ≥40 years diagnosed with biopsy-confirmed incident prostate cancer from January 2008 to December 2016. Regression modeling to analyze age-based time trends in the annual rate of active surveillance showed increases in men aged <70 years, with the highest gains in the subgroups of men aged 40 to 49 years and 50 to 59 years.
Data on receipt of follow-up procedures showed that nearly all men (90%) had a PSA test within 12 months after their cancer diagnosis. Only approximately one-third of patients, however, had undergone a repeat biopsy.
“Active surveillance has become an established management option for patients with low-risk prostate cancer and/or limited life expectancy. Previous studies evaluating its implementation used Medicare data, and so it is unclear how active surveillance is being used in younger men,” said Dr. Kim, associate professor of urology, Case Western Reserve University School of Medicine, Cleveland.
“Our research indicates that active surveillance is being promoted and disseminated in the younger, privately insured patient population. It seems, however, that increased attention is warranted to develop evidence-based active surveillance protocols to ensure safety for these patients. Ultimately, there is also a need for prospective studies to assess outcomes of active surveillance for younger patients.”