Lack of real-world evidence on active surveillance in Chinese patients with prostate cancer: insights from a 10-year cohort and a physician survey.

BACKGROUND

Active surveillance (AS) is an established management strategy for low-risk prostate cancer (PCa). However, its real-world implementation in China remains limited. This study aimed to present the outcomes of patients with early-stage PCa undergoing AS and to identify the main obstacles encountered in the promotion of AS.

METHODS

We conducted a two-part study consisting of a prospective observational cohort of patients who elected for AS at a tertiary cancer center (2012-2017) and a nationwide cross-sectional survey of urologists assessing their knowledge, attitudes, and practice patterns regarding AS. Clinical outcomes, adherence to follow-up, and treatment conversion were evaluated in the cohort. Survey responses were analyzed across hospital level and physician seniority.

RESULTS

Among the 452 patients with localized PCa evaluated during the study period, 20 met the eligibility criteria and selected AS. After a median follow-up period of 118 months, 13 patients transitioned to definitive treatment, most commonly because of suspected disease progression. Three deaths occurred, one of which was a PCa-specific death. Adherence to scheduled PSA monitoring was high, whereas repeat biopsy compliance was low. The survey included 343 valid physician responses. Familiarity with AS eligibility and follow-up protocols was significantly higher among physicians in academic hospitals and those with senior titles. However, < 10% reported having structured AS follow-up programs, and most perceived patient anxiety and preference for surgery as major barriers to AS implementation.

CONCLUSIONS

AS may be a feasible management option for carefully selected Chinese patients. Efforts to expand AS use in China should prioritize patient education, structured follow-up systems, national registry development, and supportive health policy measures.