Active surveillance under-used (back in 2010-2011)


A new research letter just published in JAMA Internal Medicine suggests that only about 12 percent or less of the men who are good candidates for active surveillance are actually being managed in that manner. But, …

The article by Maurice et al. is based on data from the 2010-2011 data set of the US National Cancer Database, and so the real message should be that in 2010-2011 only about a 12 percent or less of men who were good candidates for active surveillance at that time were being managed in that manner. Bluntly, we just don’t know what percentage of men who are appropriate candidates for active surveillance are being initially managed in that manner now, nearly 5 years later.

Basically, Maurice et al. looked at data on 189,768 men with prostate cancer in the US National Cancer Database for 2010-2011 (which was the first time that it was possible to identify men in this database who were initially managed on active surveillance). Among those men, they were able to show that:

  • 75,546 or 39.8 percent were eligible for management on active surveillance according to the Klotz/Sunnybrook criteria.
    • But only 6.5 percent of those eligible men (about 4,900) were actually managed on active surveillance.
  • 54,070 or 28.5 percent were eligible for management on active surveillance according to the D’Amico criteria.
    • But only 7.4 percent of those men (about 4,000) were actually managed on active surveillance.
  • 20,377  or 10.7 percent were eligible for management on active surveillance according to the Epstein/Johns Hopkins criteria.
    • But only 12.1 percent of those men (about 2,465) were actually managed on active surveillance.
  • About half of all the men in the database had received a radical prostatectomy

You can see more data about the levels of use of differing types of treatment in Figure 1 of the research letter. There is also additional commentary about this study in an article on the HealthDay web site.

The “New” Prostate Cancer InfoLink is not too surprised by these data from 2010-2011, and we are in complete agreement with statements by Dr. Stephen Freedland in the HealthDay article which reads as follows:

… the report’s data is outdated. The situation has ‘changed dramatically’ over the past few years, with early research suggesting that many more men are choosing the surveillance option.

Before, he said, doctors chose treatment instead of monitoring because they weren’t comfortable with watchful waiting and ‘didn’t fully appreciate how well the patients do; how safe it is to do that.’

3 Responses

  1. I would have been one of the 88% who got cut for no reason, if I had not done my own research! Thank God I did. The past 3 years of normal life with my lively wife are priceless to me.

    If someday I have to treat, so be it. But until then, … LIFE!!! :-)

  2. And neither are their underwriters. A problem with a resolution; protection for practicing IAW guidelines.

  3. And let’s be honest, neither were they comfortable with the negative financial impact that AS would have on their practice.

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