“Active surveillance” for prostate cancer has become more common in recent years. A typical prostate cancer patient might follow this procedure if the cancer isn’t causing symptoms, is expected to grow slowly, is small, is just in the prostate, and is associated with a relatively low PSA level (<10ng/ml).
In active surveillance, only men whose cancer is growing (and therefore have a more serious form of cancer) are considered for treatment. For some men, these treatments have risks and side effects that may outweigh their benefits. And for older patients (age >70) the slow growing cancer is less likely to cause serious health problems during the patient’s shorter lifetime.
Although most plaintiffs’ attorneys stress that the “standard of care” in medicine is a national standard, studies have found surprising differences in actual care patterns, depending on geography. The use of active surveillance, for example, varies dramatically state by state. On a national level, about 1/3 of men with low-risk prostate cancer were followed with active surveillance in 2015, according to a study at the University of California San Francisco. However, in New Mexico the use of active surveillance was found to be 6.3%, compared to 81% in New Jersey.
Some of the differences may be based on the populations found in different states. For example, those of Hispanic ethnicity were much less likely to utilize active surveillance compared to surgical treatment. College education was also found to lead to a much higher use of this approach. It was initially thought that the number of practicing urologists or radiation oncologists in a geographic area may be a factor, but the gaps in use were not explained by that.
The study found that there were large gaps in the growth rate of active surveillance. For example, patients in the VA health system showed substantially higher rates, which may be explained by more consistent use of shared guidelines in that system. It was also thought that acceptance of the active surveillance approach may vary, depending on what the practice pattern was in major medical centers in a particular region. But the overall conclusion was that “practice variation reflecting nonclinical factors” is a likely explanation for the variations nationally. In other words, what ethnic group you belong to — and where you live — may well influence the kind of treatment you receive.
