Adam B. Weiner, Urologic Oncologist at Cedars Sinai Medical Center, shared on X:
“93% active surveillance for low-risk prostate cancer in the VA system.
73,042 pts with NCCN low or favorable intermediate risk PCa, VA system 2005 to 2024
38,130 managed initially with surveillance or watchful waiting
- Low risk: AS use 27% to 93%
- Favorable intermediate: 14% to 61%
- GG1 with PSA 10 to 20: 27% to 88%. GG2 in <50% of cores: 11% to 55%
- For GG1 dx 2015 to 2024, nearly every VA facility sat between 60% and 100%
For context: ~60% national AS rate for low risk in AQUA those same year
Gaps remain: lower AS odds for Black (OR 0.95) and Hispanic (OR 0.85) pts and higher area deprivation, independent of risk
Bottom line: an integrated system with guideline monitoring, no financial reward for intervening, and nowhere to opinion-shop got AS to 93%.
The barrier to surveillance was never the evidence. It was the incentives.”
Title: Active Surveillance Use for Favorable-Risk Prostate Cancer in a Veterans Affairs Population
Authors: Grace Lee, John R. Bihn, John M. Culnan, Jennifer La, Nhan V. Do, Kenute Myrie, Channing J. Paller, Nathanael R. Fillmore, Matthew R. Cooperberg.
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