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