VA Shifts to Monitoring for Most Favorable‑Risk Prostate Cancers

A JAMA analysis credits the VA’s national electronic records with enabling the shift to surveillance while noting persistent gaps in access and counseling.

Overview

A JAMA study published Thursday found that in 2024, 93% of veterans with low‑risk prostate cancer and 61% with favorable intermediate‑risk disease were managed with active surveillance instead of immediate surgery or radiation.
The analysis followed more than 73,000 veterans in the VA system as part of the PROFOUND‑VET initiative that was created to develop cancer care guidelines.
Active surveillance in the study meant routine PSA blood tests every three to six months plus periodic rectal exams, MRI scans, and biopsies, with definitive treatment reserved for documented tumor progression.
Authors say the VA’s integrated electronic records, quality tracking, feedback to clinicians, and long‑term continuity of care helped drive rapid adoption, but they warn the results may not apply to fragmented fee‑for‑service settings.
The findings suggest many veterans are avoiding treatment side effects such as incontinence and erectile dysfunction, yet the study highlights persistent disparities and a need for better patient counseling and shared decision making.