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What factors affect patients’ decisions regarding active surveillance for low-risk prostate cancer?


Urologists’ recommendations and patients’ perception of their cancer seriousness have strong influences.

Because low-risk prostate cancer is unlikely to spread or impact survival, experts and guidelines recommend active surveillance, which involves regular monitoring and thus avoid or delay treatment like surgery or radiation therapy and their life-changing complications. A new study examined the rates of active surveillance use and evaluated the factors associated with selecting this management strategy over surgery or radiation, with a focus on underserved Black patients who have been underrepresented in prior studies. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

For the study, called the Treatment Options in Prostate Cancer Study, Jinping Xu, MD, MS, of Wayne State University, and her colleagues analyzed data from metro-Detroit, Michigan, and Georgia cancer registries, focusing on patient self-reported information related to Black and white patients who were newly diagnosed with low-risk prostate cancer in 2014–2017.

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. Also, participants living in metro-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 especially 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 the 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. 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,” said Dr. Xu.

Additional information
 The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout,

Full Citation:
“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 (TOPCS).” Jinping Xu, Cathryn H. Bock, James Janisse, Justin Woo, Michael L. Cher, Kevin Ginsburg, Rami Yacoub, and Michael Goodman. CANCER; Published Online: January 22, 2024 (DOI: 10.1002/cncr.35190).


Author Contact: Phillip Van Hulle, director of publications at Wayne State University, at

About the Journal     
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on Twitter @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

About Wiley      
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Follow us on Facebook, Twitter, LinkedIn and Instagram.

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