Active surveillance and watchful waiting for men diagnosed with low-risk, localized prostate cancer grew rapidly from 2010 through 2013, a new study of community-based management trends reports. Nevertheless, most low-risk patients still undergo surgical or radiation treatment, according to a review of expectant management in such men.
Matthew R. Cooperberg, MD, MPH, and Peter R. Carroll, MD, MPH, of the University of California, San Francisco, analyzed data from the Cancer of the Prostate Strategic Urologic Research Endeavor, a national registry of men diagnosed with prostate cancer at 45 urology practices since 1995. The analysis included 10,472 men, average age 66 years, with stage cT3aNoMo (localized) or lower prostate cancer (low, medium, and high risk) who were managed between 1990 and 2013 with prostatectomy, radiation, androgen deprivation monotherapy, or active surveillance/watchful waiting.
Surveillance for low-risk cancer, which had varied from 6.7% to 14% from 1990 through 2009, jumped to 40.4% from 2010 through 2013. Surveillance rates for men 75 years of age or older, which were 54% from 1990 through 1994 but decreased to 22% from 2000 through 2004, rose to 76.2% from 2010 through 2013.
“The magnitude and speed of the changes suggest a genuine change in the management of patients with prostate cancer in the United States, which could accelerate as more clinicians begin to participate in registry efforts,” wrote the authors in a research letter published in JAMA (2015; 314:80-2).
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