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Active surveillance hits 60% in the U.S., but lags far behind Canada, Holland, and Sweden

80% is the new goal

Back when I was diagnosed with low-risk prostate cancer in 2010, surgery or radiation were near inevitabilities in those dark days.

Only 6% of us opted for AS. It was pretty lonely. I didn’t meet anyone else on AS for six years.

We were the odd men out. But no longer.

In the past decade, there has been a sea change favoring AS, close monitoring of prostate cancer rather than a mad rush into the OR or the radiation suite.

Matthew Cooperberg, MD, MPH, of the University of California, San Francisco, representing a panel that reported on the State of AS Sunday at the American Urological Association, said that most patients (60%) with low-risk Gleason 6 disease in the U.S. now opt for AS.

This is a revolution in patient care. The AS rate doubled in the past seven years in the U.S., while radical prostatectomies have become increasingly rare.

Still, we lag far behind other countries, such as Holland and Sweden with 90%-plus AS adoption rates and Canada with about 80%. Critics say other countries accept AS at high levels because of national health plans.

Amazingly, urologists in the state of Michigan have a 91% uptake for AS—and Michigan doesn’t have a socialized health system.

Cooperberg told me in an interview the next goal in the U.S. will be 80% of patients with low-risk prostate cancer opting for AS. This 80% rate already has been achieved in the U.S. VA system, and likewise, rates of 90%-plus have been attained in some large-group practices and academic urology practices.

Read my story on this report in Medscape Medical News:

Many patients and their patients and spouses used to resist AS. The idea of learning to live with cancer was alien. Things have changed as thought leaders, guideline writers, researchers, and support groups have begun promoting AS as a reasonable choice that avoids the two I’s, impotence and incontinence.

Patients on AS are mainstream at long last. Read the AUA. panel’s data:

(Poster from the AUA meeting.)

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