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

Abstract

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.