Active surveillance for low-risk prostate cancer: long-term utilization and outcomes among black men.

Concerns persist that low-risk prostate cancer in non-Hispanic Black (NHB) men may be more aggressive, with clinicians uncertain if active-surveillance (AS) should be used in this population. Using the SEER Prostate Cancer Specialized Database (2010-2020), we analyzed 106,486 men with low-risk prostate cancer, of whom 16.6% were NHB. AS or watchful waiting (AS/WW) was less frequently used in NHB men compared to non-Hispanic White (NHW) men (32.9% vs 37.5%), NHB men showed consistently lower utilization of AS/WW over the years (aOR = 0.91, 95%CI: 0.86, 0.95), with absolute differences ranging from 3.4% to 8.5%. In multivariable competing risks analysis, 10-year PCSM did not significantly differ by race (SHR = 1.03, 95% CI: 0.66-1.60). These findings suggest AS/WW is a safe option for NHB men and its use may be underutilized in this group despite comparable long-term cancer-specific outcomes.