Work

Active surveillance and trajectories of decision-making among patients with low-risk prostate cancer

Year: 2026

Type: article

Abstract: Objectives Prostate cancer is the most common cancer among men in the United States. This study examines factors associated with active surveillance (AS) uptake, timing of treatment decision making, and whether timing affects quality of life. Methods We used data from a population-based observational study of 512 patients aged 40–79 diagnosed with low-risk prostate cancer from 2016 to 2022. Factors associated with AS receipt and treatment decision-making trajectories were assessed using robust Poisson regression models. Patient-reported satisfaction with treatment and PROMIS measures were analyzed using Poisson and linear regression. Results AS uptake was 70.9% in the overall sample, higher among non-Hispanic (NH) White (76.6%) and NH Asian American/Pacific Islander (75.0%) patients than among NH Black (64.1%) and Hispanic (57.3%) patients. In adjusted models, higher education was associated with greater AS uptake (prevalence ratio (PR): 1.35; 95% CI: 1.02–1.78), and Hispanic patients were less likely to choose AS (PR: 0.80; 95% CI: 0.65–0.99). Older patients were more likely to delay disease management decisions (60–69 years: PR: 1.47; 95% CI: 1.09–1.98; 70 + years: PR: 1.67; 95% CI: 1.17–2.37), while partnered patients were less likely to delay (PR: 0.69; 95% CI: 0.54–0.88). Late deciders reported lower satisfaction with treatment decisions (PR: 0.92; 95% CI: 0.85–0.99) and higher anxiety scores at follow-up (coef: 1.86; 95% CI: 0.15–3.57). Conclusions Hispanic patients, those who completed less education, and older patients face barriers to timely decisions about disease management. Partner involvement supports earlier decisions, while later decision was linked to lower satisfaction and higher anxiety.

Source: Frontiers in Human Dynamics

DOI: 10.3389/fhumd.2026.1847213