HOT OFF THE PRESSES: AS reaches new heights in U.S., UCSF’s Cooperberg
60% AS rate in 2020, up from ~6% in 2010
By Howard Wolinsky
Here’s a genuine scoop on Active Surveillance.
About 60% of patients who are candidates opt for active surveillance nationally.
That’s a big jump. The proportion of patients opting for AS only went over 50% in the past five or so years.
Matthew Cooperberg, MD, MPH, of UCSF, which AS, which is close monitoring of patients to defer or even prevent active treatment with prostatectomy or radiation, shared the 60% number in an interview with Charles Ryan, MD, CEO of the Prostate Cancer Foundation that just appeared in UroToday.
This is a rare medical breakthrough in my view. It took some bravery on the part of urologists, such as Laurence Klotz, Peter Carroll, Ballentine Carter, and Peter Albertsen 30 years ago when they realized that patients can live with most low-risk prostate cancers. They bucked the mainstream rush to treat any cancer aggressively.
Mark Scholz, MD, of Prostate Cancer Research Institute, was a big influence on patients like me back in 2010 with his co-authored book, “The Invasion of the Prostate Snatchers.”
And it also took a leap of faith in science on the part of patients who typically were pressured into the OR or the radiation suite even if they had a tiny speck of low-grade prostate cancer,
In 2010, when I was diagnosed with low-risk prostate cancer, I was a rare patient who went on AS. My doctor then, Scott, Eggener, MD, of the University of Chicago, told me that only 6%-10% of patients like me opted for AS.
Now it’s coming on 13 years for me in 2023—my prostate cancer bar mitzvah—and I’m still on AS. Brian Helfand, MD, PhD, my current urologist, told me I likely to be done with biopsies. I will do my phi (PSA) test in a few weeks to see where I stand,
Cooperberg said in the interview, “The (AS) rates have been going up quite rapidly, actually. So, the paper that we had out of UCSF from the CaPSURE Registry in 2015 showed that in the prior decade, the 2010s, we finally broke out of the 10% range where we had been stuck for many years. That's 10% of low-risk patients getting active surveillance. We had made it up to about 40% by 2013 or '14.”
Cooperberg explained that the AQUA registry is a national registry that the American Urological Association has been running since 2014, including data from about 250 practices around the country with about 280,000 prostate cancer patients.
“The rate of surveillance has continued to go up pretty much linearly up to about 60% for 2020, which is a lot of progress in the right direction, and this is probably the best source of data we've got for what is happening in general community urology practice currently, Cooperberg said.
He will be presenting the data at the upcoming AUA meeting.
Great progress, but higher rates can and should be achieved: In my opinion, 60% on AS is still too low nationally. That means of course that 40% still are opting for unnecessary treatment and taking on risks for impotence, incontinence, and other problems.
The VA overall has a 70% AS rate. Some major U.S. centers have 90% AS rates.
Ola Bratt, MD, a top Swedish urologist and a guideline writer, told me that 94% of candidates in Sweden choose AS. (https://www.statnews.com/2022/01/11/active-surveillance-for-prostate-cancer-the-gift-that-keeps-on-giving/)
Cooperberg’s been a busy guy.
(Eggenger, Cooperberg, a few more docs and me (The Active Surveillor) have a paper coming out soon on renaming Gleason 6 as something other than cancer. It will appear in the Journal of Clinical Oncology. Stay tuned.)
Cooperberg last week told Mark Moyad, MD, in an interview at PCRI (PCRI.org) mid-year meeting re the uptake of AS, stating that 80% is a good target.
“That’s probably about the right target, around 80%. It’s never going to be 100%, but that’s where they probably need to get to,” he said.
What a difference in 10 years for AS: 6% to 60%. Not as fast as those cars that go from 0 to 60 in two seconds. But progress at last.
What do you think?
join a webinar at 11 a.m. Eastern U.S. on April 22 for a webinar co-sponsored by a long list of support and advocacy organizations, including the leads, Active Surveillance Patients International and AnCan. (TheActiveSurveillor.com also is a sponsor—see all in flyer below:)
Please sign up for the program on the future of AS: "Your Voice in the Future of Active Surveillance," on April 22 at 11 a.m.Eastern/4 p.m. GMT. Register here: https://zoom.us/meeting/register/tJEtfuuqrzwtHNPuqzkigx65YBk8vV-teUdy
AnCan’s Virtual Support Group for AS is holding a webinar on “decisional regret” with low-risk prostate cancer at 8 p.m. Eastern April 6. No registration. Just go to the URL below. The program features researcher Chris Wallace, MD, PhD, who also will answer other questions on prostate cancer.
Go to the Barniskis Room: https://www.gotomeet.me/AnswerCancer Or call +1 646 749 3129 Access Code: 222-583-973 (Barniskis Room)
The Prostate Forum of Orange County is now holding its support program for newly diagnosed prostate cancer patients at 5-7 p.m.Pacific on the second Tuesday of the month starting on April 12.
Go to: https://us02web.zoom.us/j/86164783897#success
Meeting ID: 861 6478 3897
One tap mobile +16699006833,,86164783897# US (San Jose)
Dial by your location
+1 669 900 6833 US (San Jose)
+1 253 215 8782 US (Tacoma)