ASCO GU 2018: A National Survey of Radiation Oncologists and Urologists on Active Surveillance for Low-risk Prostate Cancer

San Francisco, CA ( Dr. Albert Kim and colleagues from Cleveland, OH presented results of their national survey of radiation oncologists and urologists on active surveillance for low-risk prostate cancer at today’s prostate cancer poster session at GU ASCO. Secondary to the growing concerns about over-diagnosis and overtreatment of localized prostate cancer, active surveillance has become an integral part of clinical practice guidelines. However, many men with low-risk prostate cancer still receive primary therapy with surgery or radiation. Furthermore, little is known about the barriers regarding the use of active surveillance in clinical practice. Thus, the aim of this study was to perform a national survey of radiation oncologists and urologists assessing the current attitudes and treatment for patients diagnosed with low-risk prostate cancer.

From January to July of 2017, the authors surveyed 915 radiation oncologists and 940 urologists about perceptions of active surveillance for low-risk prostate cancer. The survey queried respondents about their opinions and attitudes towards active surveillance and treatment recommendations for various patient scenarios regarding low-risk prostate cancer with clinical factors varying from patient age (55, 65 and 75 years old), PSA (4 and 8 ng/dl), and tumor volume for Gleason 3+3 disease (two, four and six cores). Pearson chi-square and multivariable logistic regression were used to identify respondent differences in treatment recommendations for low-risk prostate cancer.

The overall response rate for the survey was 37.3% (n = 691), with a similar response rate for radiation oncologists and urologists (35.7% vs. 38.7%; p = 0.18). Both radiation oncologists and urologists viewed active surveillance as effective for low-risk prostate cancer (86.5% vs. 92.0%; p = 0.04), however radiation oncologists were more likely to suggest that active surveillance increases patient anxiety (49.5% vs. 29.5%; p < 0.001). Additionally, recommendations varied markedly based on patient age, PSA, number of cores positive for Gleason 3+3 prostate cancer and respondent specialty. For example, a 55-year-old male patient with a PSA of 8 ng/dL and six cores of Gleason 3+3 prostate cancer, recommendations of AS were very low for both radiation oncologists and urologists (4.4 % vs. 5.2%; adjusted OR: 0.6; p = 0.28). For a 75-year-old patient with a PSA of 4 ng/dL and two cores of Gleason 3+3 prostate cancer, radiation oncologists and urologists most often recommended active surveillance (89.6% vs. 83.4%; adjusted OR: 0.5; p = 0.07).

The authors of this study concluded that both radiation oncologists and urologists consider active surveillance effective in the clinical management of low-risk prostate cancer. However, there is variation regarding recommending active surveillance based on patient age, prostate cancer volume, PSA and physician specialty, specifically in young men with higher volume Gleason 3+3 disease.

Speaker: Albert Kim, University Hospitals Case Medical Center, Cleveland, OH

Co-Authors: Robert Abouassaly, Simon P. Kim

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

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