前列腺癌（PCa）的治疗已从“早期发现时治疗”的模式演变为“仅在必要时治疗”。尽管其使用不一致，但主动监测在过去二十年中已发展成为低风险 PCa 管理的黄金标准。我们的目的是调查过去十年中期待治疗（积极监测、观察等待、不治疗）作为低风险 PCa 一线治疗方法的使用是否有所增加。我们查询了美国国家癌症数据库，了解 2010 年至 2020 年间诊断为局限性 PCa 的男性。两个多变量逻辑回归模型，具有不同的双向交互项（诊断年份 × D'Amico 风险分类和诊断年份 × 国际癌症协会泌尿病理学 [ISUP] 等级组）被拟合来预测接受期待治疗与积极治疗的概率。对于低风险 PCa 男性，预期治疗的预测概率从 2010 年的 13.7% 增加到 2020 年的 64.4%，对于 ISUP 1 级 PCa，预期治疗的预测概率从 2010 年的 12.9% 增加到 2020 年的 61.6%（两者的交互作用 < 0.001）。过去十年中，低风险 PCa 期待治疗的频率急剧增加。由于人们越来越认识到惰性疾病过度治疗的危害，我们预计这一趋势将进一步增加。患者摘要：我们在美国一家大型医院登记中心调查了 2010 年至 2020 年间前列腺癌期待治疗的使用情况。我们发现，接受低风险前列腺癌期待治疗的男性比例正在增加。我们的结论是，人们对过度治疗危害的认识不断增强，深刻影响了美国前列腺癌​​治疗的趋势。版权所有 © 2023 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

The management of prostate cancer (PCa) has evolved from a paradigm of "treat when caught early" to "treat only when necessary". Despite inconsistency in its use, active surveillance has evolved over the past two decades into the gold standard for management of low-risk PCa. Our objective was to investigate whether the use of expectant management (active surveillance, watchful waiting, no treatment) as a first-line approach for low-risk PCa has increased over the past decade. We queried the US National Cancer Data Base for men diagnosed with localized PCa between 2010 and 2020. Two multivariable logistic regression models with different two-way interaction terms (year of diagnosis × D'Amico risk classification, and year of diagnosis × International Society of Urological Pathology [ISUP] grade group) were fitted to predict the probability of undergoing expectant management versus active treatment. The predicted probability of expectant management increased from 13.7% in 2010 to 64.4% in 2020 for men with low-risk PCa, and from 12.9% in 2010 to 61.6% in 2020 for ISUP grade group 1 PCa (both pinteraction < 0.001). The frequency of expectant management for low-risk PCa has increased dramatically during the past decade. We expect this trend to further increase owing to the growing awareness of the harms of overtreatment of indolent disease. PATIENT SUMMARY: We examined the use of expectant management for prostate cancer between 2010 and 2020 in a large hospital-based registry from the USA. We found that the proportion of men receiving expectant management for low-risk prostate cancer is increasing. We conclude that growing awareness of the harms of overtreatment has profoundly affected trends for prostate cancer treatment in the USA.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.