Editorial Comment to Impact of Clinicopathological and Institutional Factors on the Clinical Courses of Patients With Localized Prostate Cancer Initially Managed by Active Surveillance: An Analysis of Nationwide Real‐World Data From Japan

Abstract

Onozawa et al. conducted a large-scale, multicenter observational study using the J-CaP registry to investigate the clinical trajectories and factors associated with discontinuation of active surveillance (AS) among 989 patients with localized prostate cancer (PCa) who were initially managed with AS across Japan between 2016 and 2018 [1]. A major strength of this study is its comprehensive evaluation of real-world practice across Japanese institutions, rather than focusing on patients from a single institution or those managed under a clinical trial protocol. Institutional AS uptake was closely associated with continuation: low-uptake institutions ( ≤ 33.3%) had a median AS duration of only 1.4 years, whereas continuation was longer at interme- diate-and high-uptake institutions. At low-uptake institutions, discontinuation was often driven by patient preference or physician recommendation. These findings suggest that institutional familiarity with AS may be an important component of successful long-term surveillance. However, these findings should be interpreted in the context of the 2016–2018 study period, as active surveillance practice in Japan may have since evolved. Thus, the limited uptake and continuation of AS observed in this real-world cohort may reflect a gap between guideline recommendations and their implementation in clinical practice. Bridging this gap will require not only greater familiarity with AS among physicians and patients, but also healthcare-system support that facilitates sustained surveillance