Survey: Urologist views on active surveillance for prostate cancer complex

Key Points

Chicago-Having a positive attitude regarding active surveillance for patients with low-risk prostate cancer does not correlate with the likelihood that radiation oncologists and urologists will recommend it in lieu of treatment, reported researchers at the American Society of Clinical Oncology annual meeting in Chicago.

In order to determine current opinions of prostate cancer specialists regarding active surveillance, a questionnaire was sent by mail to a random sample of 1,494 radiation oncologists and urologists. There was a 52% return rate for both specialties. The survey asked if they thought active surveillance was effective for a low-risk patient (PSA <10.0 ng/dL, Gleason 6 in one of 12 scores, clinical stage T1c), if they would be comfortable recommending it given those features, and what would be their primary recommendation for a low-risk patient aged 60 years and with life expectancy exceeding 10 years.

"To the best of our knowledge, this is the first study to perform a national survey of prostate cancer specialists about active surveillance. Our study had a relatively good response rate and the respondents constitute a heterogeneous sample encompassing a broad age range, diverse practice settings, and all geographic regions. Its results may explain in part the relatively low contemporary use of active surveillance in the U.S.," said Dr. Kim, who worked on the study with Bradley C. Leibovich, MD, Jon C. Tilburt, MD, and colleagues.

Higher perception of AS among urologists

The data showed urologists had somewhat higher perceptions about active surveillance than radiation oncologists. More than three-fourths of the urologists versus only about two-thirds of radiation oncologists indicated active surveillance was effective, and the results were the same for the question regarding their comfort in recommending active surveillance.

"It's difficult to know the reason for the difference between specialists in their rates of recommending active surveillance to a specific patient, but these data suggest it may be that more urologists felt it was effective and would be comfortable using it," Dr. Kim told Urology Times.

The survey also included questions pertaining to patients with intermediate- and high-risk disease. Dr. Kim said more details will be reported later, but again, the results showed the two groups of specialists favored treatment reflecting their own practice.

"Compared to the last national survey from 2000, the preferences of urologists and radiation oncologists for treatments were more in favor of treatments reflective of their clinical practice," he said.