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Potential for overtreatment of low-risk prostate cancer varies by region

Key clinical point: Differences in region and county-level variables accounted for 17% of differences in active surveillance of low-risk prostate cancer in multivariate analysis.

Major finding: Overall use of active surveillance or watchful waiting was 22.1% across 79,825 men with low-risk prostate cancer but ranged from 42.4% in the San Francisco-Oakland area to 4.1% in rural Georgia.

Study details: The data come from a cohort study of 79,825 men using the Surveillance, Epidemiology, and End Results (SEER) Prostate and Watchful Waiting database and the County Area Health Resource File for demographics and physician distribution data between January 2010 and December 2015.

Disclosures: The study received no outside funding. Lead author Dr. Washington had no financial conflicts to disclose. Corresponding author Matthew Cooperberg, MD, disclosed relationships with Astellas, Dendreon, Bayer, Janssen, Merck, and Astra Zeneca.


The risks of side effects from treatment for low-risk prostate cancer may exceed the potential benefits for many patients; therefore, active surveillance (AS) or watchful waiting (WW) has been recommended for a significant proportion of this population. However, uptake of new management strategies can take time. Understanding potential reasons for this may improve implementation of recommended practices. Washington III et al. utilized the SEER database and a county health database to evaluate the variations amongst geographic regions within the United States (U.S.). They identified an increase of 19% in uptake of AS or WW in the U.S. from 2010-2015. Annual percent increase in uptake ranged from 6.3% to 81% with geographic differences accounting for some variation. Other factors did not show a positive association with uptake. Further in-depth studies utilizing rigorous implementation science is needed to continue to improve optimal management of low-risk prostate cancer.”

Mark Klein, MD


Washington SL III et al. JAMA Netw Open. 2020 Dec 28. doi: 10.1001/jamanetworkopen.2020.31349.