Active Surveillance for Men with Intermediate Risk Prostate Cancer

J Urol. 2021 Jan;205(1):115-121. doi: 10.1097/JU.0000000000001241. Epub 2020 Jul 13.


Purpose: Optimal treatment of intermediate risk prostate cancer remains unclear. National Comprehensive Cancer Network® guidelines recommend active surveillance, prostatectomy or radiotherapy. Recent trials demonstrated no difference in prostate cancer specific mortality for men undergoing active surveillance for low risk prostate cancer compared to prostatectomy or radiotherapy. The use of active surveillance for intermediate risk prostate cancer is less clear. In this study we characterize U.S. national trends for demographic, clinical and socioeconomic factors associated with active surveillance for men with intermediate risk prostate cancer.

Materials and methods: This retrospective cohort study examined 176,122 men diagnosed with intermediate risk prostate cancer from 2010 to 2016 in the National Cancer Database. Temporal trends in demographic, clinical and socioeconomic factors among men with intermediate risk prostate cancer and association with the use of active surveillance were characterized. The analysis was performed in April 2020.

Results: In total, 176,122 men were identified with intermediate risk prostate cancer from 2010 to 2016. Of these men 57.3% underwent prostatectomy, 36.4% underwent radiotherapy and 3.2% underwent active surveillance. Active surveillance nearly tripled from 1.6% in 2010 to 4.6% in 2016 (p <0.001). On multivariate analysis use of active surveillance was associated with older age, diagnosis in recent years, lower Gleason score and tumor stage, type of insurance, treatment at an academic center and proximity to facility, and attaining higher education (p <0.05). Race and comorbidities were not associated with active surveillance.

Conclusions: Our findings highlight increasing active surveillance use for men with intermediate risk prostate cancer demonstrating clinical and socioeconomic disparities. Prospective data and improved risk stratification are needed to guide optimal treatment for men with intermediate risk prostate cancer.

Keywords: prostatic neoplasms; risk; watchful waiting.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Health Status Disparities*
  • Healthcare Disparities / economics
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / statistics & numerical data
  • Insurance, Health / economics
  • Insurance, Health / statistics & numerical data
  • Kallikreins / blood
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Staging
  • Prostate / pathology
  • Prostate-Specific Antigen / blood
  • Prostatectomy / economics
  • Prostatectomy / statistics & numerical data
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy*
  • Radiotherapy / economics
  • Radiotherapy / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Socioeconomic Factors
  • Watchful Waiting / economics
  • Watchful Waiting / statistics & numerical data*


  • KLK3 protein, human
  • Kallikreins
  • Prostate-Specific Antigen