Loeb, an assistant professor in the urology and population health departments at NYU School of Medicine and an attending urologist at VA New York Harbor Healthcare System, says the VA's success raises its standard of care of low-risk prostate cancer to levels seen in other countries like Sweden, where active surveillance rates top 70 percent. And it offers hope, she says, for many private clinics in the United States, which lag behind with as many as two-thirds of men at low risk undergoing early aggressive treatment, according to published estimates.

Loeb cautions that some men may opt for immediate treatment with "sound concerns" rather than active surveillance, especially men who had an infection after their initial biopsy, and fear it happening again with any further procedures. What is important, Loeb explains, is that patients and their physicians carefully review options after a diagnosis and that the risks of immediate treatment are understood when a "shared decision" is made.


Loeb credits the VA's success to several factors, noting that it is part of a national network of publicly funded hospitals, where many physicians are salaried, so there is little financial incentive to overtreat.

"The main conclusion to be drawn from the data is that if so many veterans can quickly adopt this less-risky disease-management strategy, then so too might other American men if they understood the potential benefits of this option," says Loeb.

Loeb says her team, in conjunction with the Prostate Cancer Foundation, which helped fund the current study, next plans to look at ways, such as use of online educational materials, to improve active surveillance rates.

The U.S. National Cancer Institute estimated that 26,000 American men would die from prostate cancer in 2017, with 161,000 new cases diagnosed, most in its earliest stages.

Additional funding support for the study, which took four years to complete, was provided by New York State Department of Health grant DOH01 C30697GG-3450000; National Institutes of Health grants P30 CA016087 and K07 CA178258; and Veterans Affairs grants CDA 11-257 and CDP 11-254. Funding support was also provided by the Laura and Isaac Perlmutter Cancer Center, the Edward Blank and Sharon Cosloy-Blank Family Foundation, and the Gertrude and Louis Feil family trust.

Loeb has received consulting fees or travel reimbursements from several health care and pharmaceutical companies involved in cancer care or diagnostics, including Lilly, MDxHealth, General Electric, Astellas, Sanofi, GenomeDx, Minomic and Boehringer Ingelheim. Study co-investigator Danil Makarov, MD, MHS, has also served as an advisor to the FDA, which regulates prostate therapies and diagnostic tools. All relationships are being managed in accordance with the policies and practices of NYU School of Medicine.

Besides Loeb and Makarov, other NYU Langone and Manhattan VA investigators involved in the study were Nataliya Byrne, BA; Herbert Lepor, MD; and Dawn Walter, MPH.

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