Sweden's Doctors Increasingly Choose Watchful Waiting Over Surgery for Early Prostate Cancer

<p><strong>Objective:</strong> Active surveillance (AS) is recommended for low-risk and some favourable intermediate-risk prostate cancers, but criteria for AS and deferred treatment have changed over time. We assessed time trends for the use of AS and deferred treatment.</p><p><strong>Material and methods:</strong> Nationwide Swedish register study of 76,191 men diagnosed with low- or intermediate-risk localised prostate cancer from 2008 to 2020. This study presents the proportion of men starting on AS, their clinical characteristics and proportion having deferred treatment. Cox regression was used to calculate hazard ratios for deferred treatment. Subgroup analyses were performed for men &lt; 60 years with Charlson Comorbidity Index 0.</p><p><strong>Results:</strong> Overall use of AS increased from 2008–2010 to 2017–2020: any low-risk: 40% to 81%, very low-risk disease: 57% to 91%, other low-risk: 37% to 77% and intermediate-risk: 16% to 20%. The relative increase in the use of AS in men &lt; 60 years with Charlson Comorbidity Index 0 was similar to, or greater than, the increase overall. A total of 28,211 men started on AS. The crude proportions of men receiving deferred treatment were relatively stable over time; 2017–2020: very low-risk disease 8%, other low-risk 16% and intermediate-risk 23%. After adjustment for clinical characteristics, deferred treatment within 2 years decreased over time for very low-risk, was stable for other low-risk and increased for intermediate-risk cancer.</p><p><strong>Conclusions:</strong> The use of AS greatly increased over time, not least amongst younger healthy men, whereas the use of deferred treatment was relatively stable. AS has been increasingly accepted as a safe approach for localised, favourable-risk prostate cancer.</p>