Prostate Cancer Active Surveillance Increasing in the US

Share this content:
From 2010 to 2015, active surveillance/watchful waiting increased from 14.5% to 42.1%, according to a new study.
From 2010 to 2015, active surveillance/watchful waiting increased from 14.5% to 42.1%, according to a new study.

Use of active surveillance (AS) and watchful waiting (WW) for low-risk prostate cancer (PCa) increased from 2010 to 2015 in the United States.

To determine contemporary national trends, Brandon A. Mahal, MD, of the Dana-Farber Cancer Institute in Boston, and colleagues queried the Surveillance, Epidemiology, and End Results (SEER) Prostate AS/WW database. Of 164,760 men with localized PCa, 20,879 (12.7%) received AS/WW, 68,350 (41.5%) radiation therapy (RT), and 75,531 (45.8%) radical prostatectomy (RP) during the 5-year period.

According to an online report in JAMA, significantly fewer men were diagnosed with low-risk disease in 2015 than in 2010 (24.5% vs 34.2%) and at significantly older ages (median 65 vs 64 years) and with significantly higher PSA (median 6.7 vs 6.0 ng/mL). For the 50,302 men with low-risk disease, AS/WW increased from 14.5% in 2010 to 42.1% in 2015. Concurrently, RP significantly decreased from 47.4% to 31.3% and RT from 38.0% to 26.6%.

For the 81,836 men with intermediate-risk PCa, AS/WW significantly increased from 5.8% to 9.6% over the period. Meanwhile, RP significantly decreased from 51.8% to 50.6% and RT from 42.4% to 39.8%.

The investigators observed concerning trends in the 32,622 patients with high-risk disease. Low AS/WW use endured from 1.9% in 2010 to 2.2% in 2015. But RP spiked significantly from 38.0% to 42.8%, whereas RT declined from 60.1% to 55.0%.

“Although increasing use of AS/WW for low-risk disease has been supported by high-level evidence and guidelines since 2010, shifting management patterns toward more radical prostatectomy in higher risk disease and away from radiotherapy does not coincide with any new level 1 evidence or guideline changes,” according to Dr Mahal and the team.


  1. Mahal BA, Butler S, Franco I, et al. Use of active surveillance or watchful waiting for low-risk prostate cancer and management trends across risk groups in the United States, 2010-2015. JAMA (Published online February 11, 2019). DOI:10.1001/jama.2018.19941

Related Resources

You must be a registered member of Cancer Therapy Advisor to post a comment.

Sign Up for Free e-newsletters

Regimen and Drug Listings


Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Prostate Cancer Regimens Drugs
Rare Cancers Regimens
Renal Cell Carcinoma Regimens Drugs
Skin Cancer Regimens Drugs
Urologic Cancers Regimens Drugs