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More patients are choosing active surveillance for early-stage prostate cancer
Last reviewed: 02.07.2025
Prostate cancer is the second most common cancer among men (after skin cancer) and is the second leading cause of cancer death (after lung cancer).
Key findings of the new study
A new study led by researchers at Yale Cancer Center and published in JAMA found a significant increase in the use of active surveillance (AS) and watchful waiting (WW) strategies over the past decade. These approaches give men the opportunity to avoid or delay the side effects of aggressive treatment while remaining under regular medical supervision.
What is AS and WW?
Active surveillance and watchful waiting include:
- Regular testing and inspections.
- The goal is to avoid unnecessary treatment when the risk of cancer progression is low.
- Possibility of surgical intervention if the condition worsens.
Objectives of the study
According to the study's senior author, Dr. Michael Lipman:
"One of the challenges of treating localized prostate cancer is assessing the risk for an individual patient. Many types of prostate cancer do not spread and do not cause symptoms unless they are treated."
Dr. Lipman noted that there have been significant changes in the past decade, with active surveillance becoming more common in "low-risk" tumors. The goal of the study was to determine whether the use of AS/WW has increased for patients with intermediate-risk tumors.
Research Methodology
- Data source: The Surveillance, Epidemiology, and End Results (SEER) program, which collects information on cancer in different regions of the United States.
- Selection criteria: Diagnosis of "intermediate-risk prostate cancer" based on parameters such as:
- Gleason score (the degree of aggressiveness of the tumor under a microscope).
- PSA level (a blood test that indicates the presence of cancer).
- Tumor stage.
Key Results
- The number of patients with intermediate-risk cancer choosing AS/WW has more than doubled:
- In 2010 – 5.0%.
- In 2020 - 12.3%.
- However, for patients with the most aggressive tumors in the average-risk group, no changes were observed.
Researchers' comments
Dr. Lipman noted:
"These results demonstrate growing interest and confidence in monitoring early stage prostate cancer. This is an important step towards reducing overtreatment of tumours that pose relatively low risk to patients."
However, the researchers stress the importance of further studying long-term outcomes and the role of new technologies, such as cancer risk biomarkers, to personalize treatment decisions.
Conclusions and recommendations
- Personalized approach: The study results confirm that men with less aggressive forms of cancer are more likely to choose AS/WW, which is consistent with data on favorable long-term prognoses.
- National Standards: Researchers call for standards and improved quality of monitoring of patients under AS/WW.
- Future research: Work is needed to refine the criteria for the onset and termination of AS/WW, including the integration of biological risk markers.
This approach helps patients avoid the side effects of surgery or radiation therapy by providing more individualized treatment plans based on tumor characteristics and patient preferences.