What does this research mean for the field?

In patients with low or favorable-intermediate risk prostate cancer, conservative management uptake is 16%, and among those managed conservatively, the 10-year incidence of initiating curative treatment is 22%. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to estimate the uptake of conservative management and the initiation of curative treatment over ten years in low-risk prostate cancer patients.

April 5, 2026

Abstract 2346: Uptake of conservative management, and uptake of curative-intent treatment following conservative management, in low and favorable-intermediate risk prostate cancer patients.

Key Result

Conservative management uptake was 16% in low or favorable-intermediate risk prostate cancer patients, with a 10-year curative treatment incidence of 22% among those managed conservatively.

Key Points

The aim is to estimate the uptake of conservative management and the initiation of curative treatment over ten years in low-risk prostate cancer patients.
Analyzed a cohort of 2,872 males diagnosed with low or favorable-intermediate risk prostate cancer from 1986 to 2019.
Used Poisson regression to assess variations in conservative management uptake by age, calendar year, risk group, and socioeconomic status.
Estimated 10-year rates of curative treatment initiation using Fine and Gray models, adjusting for competing risks of progression and other-cause death.
Conservative management was taken up by 16% of patients, with higher rates in older individuals and those from higher socioeconomic neighborhoods.
10-year incidence of curative treatment initiation following conservative management was 22%.
Younger age at diagnosis and healthier post-diagnostic lifestyles increased the likelihood of proceeding to curative treatment.

Structured PICO

Population

2,872 males with low-risk (grade group 1, stage≤cT2a, PSA<10ng/ml) and favourable-intermediate risk (grade group 1, stage cT2b-cT2c or PSA 10-20ng/ml, or grade group 2, stage≤cT2a and PSA<10ng/ml) prostate cancer diagnosed 1986-2019 (participants in the Health Professionals Follow-up Study).

Intervention

Conservative management

Outcome

Probability of conservative management uptake and 10-year rates of curative treatment initiation following conservative management

In a prospective cohort of men with low or favorable-intermediate risk prostate cancer, 16% opted for conservative management, of whom 22% initiated curative treatment within 10 years, with uptake influenced by age, calendar year, risk group, and socioeconomic status.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Low-risk and favourable-intermediate risk prostate cancer patients are eligible for conservative management. We estimated the probability of conservative management uptake and 10-year rates of curative treatment initiation following conservative management in a prospective cohort of 2,872 health professionals diagnosed with low or favorable-intermediate risk prostate cancer. Methods The study included males with low-risk (grade group 1, stage≤cT2a, prostate-specific antigen (PSA)10ng/ml) and favourable-intermediate risk (grade group 1, stage cT2b-cT2c or PSA 10-20ng/ml, or grade group 2, stage≤cT2a and PSA10ng/ml) prostate cancer whom were diagnosed 1986-2019 and were participants in the Health Professionals Follow-up Study. We estimated the variation in conservative management uptake by age and calendar year at diagnosis, prostate cancer risk group, and pre-diagnostic lifestyle using Poisson regression. We estimated 10-year rates of curative treatment initiation in patients that initially received conservative management using Fine and Gray models adjusted for competing risks of lethal progression (prostate cancer death, metastasis, or initiation of hormone therapy) and other-cause death, censoring at December 2022. We assessed the variation in continuation to curative treatment with Cox models. Results The uptake of conservative management was 16% (444/2872). Conservative management was higher in older patients (1 year of additional age - Relative Risk (RR): 1.08, 95% CI: 1.06 - 1.11), in later calendar years (1 additional year - RR: 1.07, 95% CI 1.05 - 1.10)), and in neighborhoods of higher socioeconomic status (1 standard deviation rise - RR: 1.16. 95% CI 1.03 - 1.30). Uptake was lower in favorable-intermediate risk, rather than low-risk, prostate cancer (RR: 0.47. 95% CI 0.35 - 0.61). Among the 444 patients who initially received conservative management, when adjusted for competing risks of lethal progression and other-cause death, the 10-year curative treatment incidence was 22%. Patients were more likely to continue to curative treatment if they were younger at diagnosis (1 year of additional age - Hazard Ratio (HR): 0.96, 95% CI: 0.93 - 0.99) or had healthier post-diagnostic lifestyles (increase of 1 in joint measure of physical activity, BMI, and smoking, scored 0-3 - HR: 1.47, 95% CI 1.01 - 2.15). Conclusion We found age at diagnosis, calendar year at diagnosis, prostate cancer risk group, and neighborhood-level socioeconomic status to affect conservative management uptake, and age at diagnosis and post-diagnostic lifestyle to affect rates of curative treatment initiation following conservative management, in low/favorable-intermediate risk prostate cancer patients. These results could inform the clinical management of low/favorable-intermediate risk prostate cancer. Citation Format: Isaac Allen, Jane Bailey Vaselkiv, Hannah E. Guard, Sinead Flanagan, Hari Iyer, Kevin Kensler, Jaime E. Hart, Mark A. Preston, Andreas Pettersson, Keyan Salari, Edward L. Giovannucci, Adam S. Kibel, Lorelei A. Mucci, Timothy Rebbeck. Uptake of conservative management, and uptake of curative-intent treatment following conservative management, in low and favorable-intermediate risk prostate cancer patients abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 2346.

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