Active surveillance for low-risk prostate cancer: long-term utilization and outcomes among Black men

Concerns persist that low-risk prostate cancer in non-Hispanic Black men may be more aggressive, with clinicians uncertain whether active surveillance should be used in this population. Using the Surveillance, Epidemiology, and End Results Prostate Cancer Specialized Database (2010-2020), we analyzed 106 486 men with low-risk prostate cancer, of whom 16.6% were non-Hispanic Black. Active surveillance or watchful waiting was less frequently used in non-Hispanic Black men than in non-Hispanic White men (32.9% vs 37.5%). In fact, non-Hispanic Black men showed consistently lower use of active surveillance/watchful waiting over the years (adjusted odds ratio = 0.91, 95% confidence interval [CI] = 0.86 to 0.95), with absolute differences ranging from 3.4% to 8.5%. In multivariable competing risks analysis, 10-year prostate cancer-specific mortality did not statistically significantly differ by race (subdistribution hazard ratio = 1.03, 95% CI = 0.66 to 1.60). These findings suggest that active surveillance/watchful waiting is a safe option for non-Hispanic Black men, and it may be underutilized in this group, despite comparable long-term cancer-specific outcomes.