Because low-risk prostate cancer is most likely to grow very slowly, or not at all, experts recommend active surveillance, which involves regular monitoring to avoid or delay treatment like surgery or radiation therapy and their life-changing complications. A new study by a Wayne State University School of Medicine professor examined the rates of active surveillance use and evaluated the factors associated with selecting this management strategy over surgery or radiation. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
For the study, “Determinants of active surveillance uptake in a diverse population-based cohort of men with low-risk prostate cancer: The Treatment Options in Prostate Cancer Study,” Jinping Xu, M.D., M.S., chair of the Wayne State University Department of Family Medicine and Public Health Sciences, and her colleagues analyzed data from metropolitan Detroit and Georgia cancer registries, focusing on patient self-reported information related to Black and White patients newly diagnosed with low-risk prostate cancer from 2014 to 2017.
Among 1,688 patients, 57% chose active surveillance (51% of Black patients and 61% of White patients) over other treatments. After adjusting for other influencing factors, the strongest determinant of active surveillance uptake was a urologist’s recommendation to choose this option. Other factors linked with the decision to undergo active surveillance included a shared patient-physician treatment decision and greater knowledge about prostate cancer. The study also found that participants in metropolitan Detroit were more likely to choose active surveillance than those living in Georgia.
Conversely, men were less likely to try active surveillance if their considerations were strongly influenced by the desire to achieve a “cure” or they expected to “live longer” with treatment, or if they perceived that their low-risk prostate cancer diagnosis was more “serious.”
Education and interventions for patients and urologists that address these factors may increase the use of recommended active surveillance among individuals with low-risk prostate cancer.
“I am glad to see that majority of our study participants selected active surveillance, which indicates that acceptance has improved over the last decade, however, there is room for greater acceptance,” Dr. Xu said. “Our study findings shed new light on potentially modifiable factors that can help further increase active surveillance use among patients with newly-diagnosed low-risk prostate cancer to avoid unnecessary invasive treatment and improve their quality of life.”
Other members of the study team include Associate Professor Cathryn Bock, M.P.H., Ph.D., of the WSU Department of Oncology; Associate Professor James Janisse, Ph.D., and Justin Woo, M.P.H., of the WSU Department of Family Medicine and Public Health Sciences; Professor and Chair Michael Cher, M.D., and Assistant Professor Kevin Ginsburg M.D., of the WSU Department of Urology; and Assistant Professor Rami Yacoub, M.D., and Professor Michael Goodman, M.D., Ph.D., of the Department of Epidemiology at the Emory University Rollins School of Public Health.