中危前列腺癌的初始治疗正在不断发展，目前尚无明确的治疗建议。对新诊断的中危前列腺癌患者进行主动监测的数据可能有助于阐明新兴趋势。进一步描述美国国家中危前列腺癌初始管理的趋势。这项队列研究包括诊断为中危前列腺癌的患者2010年1月1日至2020年12月31日。符合条件的患者在国家癌症数据库中的美国医院诊断；国家综合癌症网络风险分层指南用于描述有利与不利的中等风险。分析于 2023 年 9 月进行。主动监测与手术和/或放疗干预或不治疗。中危前列腺癌男性中人口、临床和社会经济因素的时间趋势及其与主动监测使用的关系；对那些具有有利与不利的中等风险分类的人进行了进一步的亚组分析。2010年至2020年间，总共确定了289584名被诊断患有中等风险前列腺癌的男性（46147名黑人[15.9%]，230071名白人[79.5%] ）。在患者中，153726 例（53.1%）接受了前列腺切除术，107152 例（37.0%）接受了放疗，15847 例（5.5%）接受了主动监测作为初始治疗策略。总体而言，整个队列的主动监测从 2010 年 21457 名患者中的 418 名患者 (2.0%) 增加到 2020 年 28192 名患者中的 2428 名患者 (8.6%)，翻了两番 (P < .001)。积极监测的中危前列腺癌男性患者的主动监测从 2010 年 12858 名患者中的 317 名 (2.4%) 增加到 2020 年的 12902 名患者中 (13.5%) (P < .001)。在不利的中危队列中，主动监测从2010年8181名患者中的101名（1.2%）增加到2020年12861名患者中的408名（3.1%）（P < .001）。在多变量分析中，主动监测的使用与年龄增加（年龄 70-80 岁 vs <50 岁：比值比 [OR]，3.09；95% CI，2.66-3.59）、较低的格里森评分（3  3 vs 3  4）相关。 ：OR，3.45；95% CI，3.25-3.66），早期 T 期（T2c 与 T1a 至 T2a：OR，0.35；95% CI，0.32-0.38），在学术中心治疗（社区与学术中心：OR， 0.72；95% CI，0.67-0.78）、较高教育水平（21% 或以上人口未受过高中教育的社区与低于 7% 的社区：OR，0.73；95% CI，0.67-0.79）、保险类型（医疗保险或其他政府服务与私人服务：OR，1.11；95% CI，1.07-1.16）、距治疗设施的距离（大于 120 英里与小于 60 英里：OR，0.75；95% CI，0.68-0.84）、设施位置（南大西洋 vs 新英格兰：OR，0.54；95% CI，0.46-0.53），收入较低（低于 38000 美元 vs 63000 美元或以上：OR，1.22；95% CI，1.14-1.31）。这些发现强调了增加在中危前列腺癌的初始管理中实施主动监测。结合基因组学和数字病理学人工智能以及新颖的监测策略的改进风险分层的前瞻性数据可能会继续更好地描述该患者群体的最佳治疗建议。

Initial management of intermediate-risk prostate cancer is evolving, with no clear recommendation for treatment. Data on utilization of active surveillance for patients with newly diagnosed intermediate-risk prostate cancer may help clarify emerging trends.To further characterize US national trends of initial management of intermediate-risk prostate cancer.This cohort study included patients with intermediate-risk prostate cancer diagnosed from January 1, 2010, to December 31, 2020. Eligible patients were diagnosed in US hospitals included in the National Cancer Database; National Comprehensive Cancer Network risk stratification guidelines were used to characterize as favorable vs unfavorable intermediate risk. Analysis was performed in September 2023.Active surveillance vs intervention with surgery and/or radiation or no treatment.Temporal trends in demographic, clinical, and socioeconomic factors among men with intermediate-risk prostate cancer and their association with the use of active surveillance; further subgroup analysis was conducted for those with favorable vs unfavorable intermediate risk classification.In total, 289 584 men diagnosed with intermediate-risk prostate cancer were identified from 2010 to 2020 (46 147 Black [15.9%], 230 071 White [79.5%]). Among patients, 153 726 (53.1%) underwent prostatectomy, 107 152 (37.0%) underwent radiotherapy, and 15 847 (5.5%) underwent active surveillance as initial treatment strategy. Overall, active surveillance quadrupled from 418 of 21 457 patients (2.0%) in 2010 to 2428 of 28 192 patients (8.6%) in 2020 for the entire cohort (P < .001). Active surveillance increased from 317 of 12 858 patients (2.4%) in 2010 to 2020 of 12 902 patients (13.5%) in 2020 in men with favorable intermediate-risk prostate cancer (P < .001). In the unfavorable intermediate-risk cohort, active surveillance increased from 101 of 8181 patients (1.2%) in 2010 to 408 of 12 861 patients (3.1%) in 2020 (P < .001). On multivariable analysis, use of active surveillance was associated with increased age (age 70-80 years vs <50 years: odds ratio [OR], 3.09; 95% CI, 2.66-3.59), lower Gleason score (3 + 3 vs 3 + 4: OR, 3.45; 95% CI, 3.25-3.66), early T stage (T2c vs T1a through T2a: OR, 0.35; 95% CI, 0.32-0.38), treatment at an academic center (community vs academic center: OR, 0.72; 95% CI, 0.67-0.78), higher level of education (communities with 21% or higher population without high school vs less than 7%: OR, 0.73; 95% CI, 0.67-0.79), insurance type (Medicare or other governmental service vs private: OR, 1.11; 95% CI, 1.07-1.16), proximity to treatment facility (greater than 120 miles vs less than 60 miles: OR, 0.75; 95% CI, 0.68-0.84), facility location (South Atlantic vs New England: OR, 0.54; 95% CI, 0.46-0.53), and lower income (less than $38 000 vs $63 000 or greater: OR, 1.22; 95% CI, 1.14-1.31).These findings highlight increasing implementation of active surveillance in the initial management of intermediate risk prostate cancer. Prospective data with improved risk stratification incorporating genomics and digital pathology artificial intelligence as well as novel surveillance strategies may continue to better delineate optimal treatment recommendations in this patient population.