Three decades after researchers at the University of California, San Francisco (UCSF) pioneered active surveillance for low-risk prostate cancer, the approach has become the predominant choice among veterans with the diagnosis, according to a recent study published in JAMA.
Researchers from UCSF and the San Francisco VA Health Care System followed more than 73,000 veterans enrolled in the VA system. In 2024, 93% of veterans with low-risk prostate cancer underwent active surveillance, compared with 27% in 2005. Among veterans with favorable intermediate-risk disease, the rate increased to 61% in 2024 from 14% in 2005.
Monitoring instead of immediate treatment
Active surveillance involves monitoring the tumor with regular testing rather than immediately treating it. Patients typically undergo prostate-specific antigen (PSA) blood tests every three to six months, along with less frequent rectal examinations, MRI scans, and biopsies. If testing indicates that the cancer has grown, surgery or radiation may then be considered.
UCSF played a foundational role in establishing active surveillance as the national standard of care for low-risk prostate cancer. According to the researchers, studies have found similar survival outcomes with surveillance and treatment, while surveillance carries lower risks of urinary incontinence, bowel problems, and erectile dysfunction.
“Prostate cancer screening saves thousands of lives by finding aggressive cancers early, but it also detects many slow-growing cancers that do not spread, and should not be treated except in rare situations,” said senior author Matthew Cooperberg, MD, MPH, Helen Diller Family Chair in the UCSF Department of Urology in a recent UCSF article.
“Many experts are recommending that we not even call these ‘cancers,’” added Cooperberg, who also practices at the San Francisco VA Health Care System. “Patients with early disease who say they prefer treatment may need better counseling.”
VA system may support broader use
First author Grace Lee, MD, a fifth-year resident physician in the UCSF Department of Urology who also practices at the San Francisco VA Health Care System, said active surveillance is more likely to be used in the VA system than in outside clinical practices.
“The VA is an integrated healthcare system that has robust practices for tracking quality of care and providing feedback to physicians, and facilitates long-term continuity of patient care,” she said.
The study was conducted by PROFOUND-VET, a research initiative within the US Department of Veterans Affairs established to develop cancer guidelines.
Note: This news summary was generated by AI based on a published press release, followed by a review from human editors.
