Survey of determinants of active surveillance uptake in a cohort of men with low-risk prostate cancer

Active surveillance (AS) is the preferred strategy for low-risk prostate cancer (LRPC); however, limited data on determinants of AS adoption are available. The Treatment Options in Prostate Cancer Study at Wayne State University (Detroit, MI) included men (aged ≤ 75 years) with newly diagnosed LRPC who completed a survey evaluating factors influencing AS uptake. Among 1688 study participants, 57% chose AS (51% of Black participants and 61% of White participants). The strongest determinant of AS uptake was AS recommendation by a urologist (adjusted prevalence ratio 6.59; 95 CI 4.84-8.97). Other factors associated with the choice for AS were a shared patient-physician treatment decision and greater prostate cancer knowledge. Men whose decision was strongly influenced by the desire to achieve ‘cure’ or ‘live longer’ with treatment and those who perceived their LRPC diagnosis as more serious were less likely to choose AS. Age, race, and education level were no significant predictors of AS uptake in adjusted analysis.