Rising active surveillance rates/observation and regimen intensification in young men: A retrospective cohort study of national commercial health insurance claims data.

OBJECTIVE: To analyze active surveillance/observation (AS/O) trends, treatment selection, treatment-free survival, and surveillance regimen intensity in men <65 using a national commercial health insurance claims database. MATERIALS AND METHODS: We retrospectively reviewed the MerativeTM Marketscan® Commercial Database for localized prostate cancer among men <65 years between 2004-2023. Each had a newly-diagnosed prostate cancer, a biopsy <180 days before diagnosis, and >2 evaluation and management visits for prostate cancer. The primary outcomes were treatment selection and health services claims after diagnosis. Descriptive statistics and Kaplan-Meier analyses are reported. RESULTS: We identified 29,484 men <65 years with localized prostate cancer, with median age 58.0 years (IQR 55.0-61.0). AS/O increased from 10.4% to 35.1%, while prostatectomy decreased from 55.5% to 42.8%. Overall, 5,861 (19.9%) men underwent AS/O in the first year after diagnosis; 4,561 (77.8%) remained on AS/O. After one year of AS/O, treatment-free survival rates at 2-, 3-, and 5- years were 86.1% (95%CI:85.1%-87.0%), 79.0% (77.8%-80.2%), and 68.8% (67.1%-70.4%), respectively. In the first two years of AS/O, men who had a urologist visit rose from 88.5% to 91.1%, biopsy from 18.0% to 48.9%, MRI from 0.0% to 63.7%, and PSA from 59.0% to 97.0%. CONCLUSIONS: Younger men have increased adoption of AS/O and intensified AS/O regimens over time. These shifting treatment patterns could be due to improved guideline implementation or acceptance of AS/O to preserve functional status.