VA System Sees Sharp Rise in Watchful Waiting for Low-Risk Prostate Cancer

A study of the Veterans Affairs Healthcare System found that active surveillance for low-risk prostate cancer jumped from 27% in 2005 to 93% by 2024, and from 14% to 61% for favorable intermediate-risk disease. The shift aligns with growing evidence and guideline support, though Black and Hispanic men were less likely to receive this approach. Rates varied widely across individual VA facilities, ranging from 23% to 93%.

The study tracked over two decades of VA data, showing active surveillance for low-risk prostate cancer climbed from just over a quarter of cases in 2005 to more than nine in ten by 2024. For favorable intermediate-risk tumors, the rate rose from 14% to 61%. Notably, facility-level variation remained wide—overall surveillance ranged from 23% to 93% across VA sites, though for grade group 1 cancers diagnosed after 2015, most facilities used surveillance in 60–100% of cases, with one outlier at 26%.

The authors linked this shift to converging evidence from randomized trials and long-term cohort studies, plus unified guideline support and patient advocacy. They also noted that older men and those diagnosed more recently were more likely to receive surveillance, while Black and Hispanic men were less likely—a disparity the study highlights without fully explaining. The VA's integrated structure may have helped standardize practice, contrasting with community settings where financial incentives can drive overtreatment.