AUA 2022: Active Surveillance for Low-Risk Prostate Cancer: Time Trends and Variation in the AUA Quality (AQUA) Registry

(UroToday.com) In a podium presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Matthew Cooperberg presented an assessment of the uptake of active surveillance in the United States based on data from the AUA Quality (AQUA) Registry. This is relevant as there has been relatively slow and variable uptake of this treatment approach for low-risk prostate cancer in the United States, despite being widely endorsed by major guidelines. Numerous other studies have assessed this question but have been limited by the generalizability of their cohort or a lack of timeliness due to a long lag between diagnosis and data accessibility.


To address this, the authors collected data from men with newly diagnosed prostate cancer in the AQUA Registry comprising 1906 urology providers at 206 practices.

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The authors included patients who had known primary treatment and sufficient data to determine D’Amico risk group. They defined a low-risk cohort as those with Gleason grade group 1, PSA < 10 ng/ml, and missing T stage. Patients were defined as having received active surveillance based on the absence of active treatment and evidence of ongoing monitoring, augmented with natural language processing of physician notes. The authors examined patterns of treatment over time and across individual practices and providers.

Between 2014 and 2019, the authors identified 84,596 eligible men in AQUA. Them median (IQR) age was 66 years (61-72). Among those for whom race was known, 79.6% were White, 15.9% Black, 1.8% Asian/Pacific Islander, 0.3% Native American, and 2.5% of other races/ethnicities.

Among all included men, 20.3% of men had low-risk disease at diagnosis. As other studies have shown, the proportion of men newly diagnosed with low-risk disease has been decreasing over time from 24.6% in 2014 to 14.0% in 2019. Overall, across this same time period, 37.1% of men with low-risk and 14.8% of men with intermediate-risk men chose AS as their primary treatment. Interestingly, these figures did not vary meaningfully between White men (35.3% of low, 12.3% of intermediate risk) and Black men (34.1% of low, 12.2% of intermediate). Utilization of active surveillance rose over time for low-risk men from 29.6% in 2014 to 49.5% in 2019 and for intermediate-risk men from 10.4% to 20.4%.

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At both the practice and provider level, use of active surveillance for men with low-risk disease ranged from 0 to 100%; provider-level active surveillance use correlated with practice-level active surveillance use (r=0.65, p<0.01), but with extensive provider variation within each practice.

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Dr. Cooperberg thus concluded that these data from the AUA Quality Registry show that utilization of active surveillance for men with low- and intermediate-risk prostate cancer have risen sharply across the US in the past half-decade but are still suboptimal for low-risk disease in particular. Further, there is substantial variation in uptake, highlighting the need for ongoing work to improve and standardize treatment approaches for these patients.

Presented by: Matthew R. Cooperberg, MD, UCSF Helen Diller Family Comprehensive Cancer Center

Written by: Christopher J.D. Wallis, University of Toronto Twitter: @WallisCJD during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.