Active surveillance could apply to one-quarter of Korean prostate cancer cases: Insights from a 27,075-patient cohort

Abstract

Background The aims of this study were to estimate an upper bound for the proportion of men newly diagnosed with prostate cancer in Korea who could be managed with active surveillance (AS) when favorable intermediate-risk disease is included and to describe variation in AS eligibility by calendar year, administrative district, and residential setting. Materials and methods We analyzed biopsy-confirmed prostate cancer diagnosed in 2010, 2012, 2014, 2016, 2018, and 2020 across 51 general hospitals nationwide. Risk was classified using routinely collected clinicopathologic variables (prostate-specific antigen, clinical T stage, Gleason grade group, and biopsy core involvement); AS eligibility was defined as the union of low risk, potentially low risk, and favorable intermediate risk. Group differences in proportions were evaluated using chi(2) tests; temporal trend was assessed using a Cochran-Armitage trend test. Primary analyses used complete cases. Results Among 27,075 men (37.9% of nationally reported cases in the indexed years), 1,476 (5.45%) were low risk, 1,082 (4.00%) potentially low risk, 4,028 (14.88%) favorable intermediate risk, 5,880 (21.72%) unfavorable intermediate risk, and 14,609 (53.94%) high risk. Overall, 6,586 (24.3%) were AS-eligible. By year, AS eligibility decreased from 27.6% (2010) to 22.0% (2020) (p < 0.001). Across 17 districts, eligibility ranged from 16.9% (Chungbuk) to 29.3% (Gyeonggi) (p < 0.001). Urban areas (dong) had higher eligibility than rural areas (eup/myeon): 26.4% versus 20.5% (p < 0.001). Conclusions Approximately one-quarter of newly diagnosed men in Korea appear potentially eligible for AS under a maximized definition that includes favorable intermediate-risk disease. AS eligibility differed significantly by year, region, and residential setting. (c) 2026 The Asian Pacific Prostate Society. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).