Most veterans with low-risk prostate cancer choose active surveillance

Three decades after UC San Francisco pioneered "active surveillance" for patients with low-risk prostate cancer, a new study has found that the vast majority of veterans with the diagnosis pursued this option instead of treatment. 

In 2024, 93% of veterans with low-risk prostate cancer underwent active surveillance-i.e. monitoring tumors with regular tests-compared to 27% in 2005, according to the study, which was published in JAMA on Aug. 13. At the same time, among veterans with favorable intermediate risk, the rate rose to 61% in 2024 from 14% in 2005. 

For the study, researchers from UCSF and the San Francisco VA Health Care System followed more than 73,000 veterans enrolled in the VA system. 

Active surveillance includes blood tests for prostate-specific antigen (PSA), a protein produced by prostate tissue, every 3 to 6 months, together with less frequent rectal exams, MRI, and biopsies. If the cancer is found to have grown, surgery or radiation is considered. 

UCSF played a foundational role in making active surveillance the national standard of care for low-risk prostate cancer. Studies have shown similar survival outcomes for surveillance compared to treatment, with lower risks of urinary incontinence, bowel problems, or erectile dysfunction. 

Prostate cancer screening saves thousands of lives by finding aggressive cancers early, but it also detects many slow-growing cancers that do not spread, and should not be treated except in rare situations."

Matthew Cooperberg, MD, MPH, senior author, Helen Diller Family Chair in the UCSF Department of Urology

"Many experts are recommending that we not even call these 'cancers,'" added Cooperberg, who also practices at the San Francisco VA Health Care System. "Patients with early disease who say they prefer treatment may need better counseling." 

A surveillance approach is more likely in the VA system than in outside clinical practices, said first author Grace Lee, MD, a fifth-year resident physician in the UCSF Department of Urology, who also practices at the San Francisco VA Health Care System. "The VA is an integrated healthcare system that has robust practices for tracking quality of care and providing feedback to physicians, and facilitates long-term continuity of patient care," she said. 

The study was conducted by PROFOUND-VET, a research initiative within the U.S. Department of Veteran Affairs that was established to develop cancer guidelines.