Although prediction tools for prostate cancer (PCa) are essential for high-quality treatment decision-making, little is known about the degree of confidence in existing tools and whether they are used in clinical practice from radiation oncologists (RO) and urologists (URO). Herein, we performed a national survey of specialists about perceived attitudes and use of prediction tools.
In 2017, we invited 940 URO and 911 RO in a national survey to query their confidence in and use of the D'Amico criteria, Kattan Nomogram, and CAPRA score. The statistical analysis involved bivariate association and multivariable logistic regression analyses to identify physician characteristics (age, gender, race, practice affiliation, specialty, access to robotic surgery, ownership of linear accelerator and number of prostate cancer per week) associated with survey responses and use of active surveillance (AS) for low-risk PCa.
Overall, 691 (37.3%) specialists completed the surveys. Two-thirds (range 65.6-68.4%) of respondents reported being "somewhat confident", but only a fifth selected "very confident" for each prediction tool (18.0-20.1%). 19.1% of specialists in the survey reported not using any prediction tools in clinical practice, which was higher amongst URO than RO (23.9 vs. 13.4%; p < 0.001). Respondents who reported not using prediction tools were also associated with low utilization of AS in their low-risk PCa patients (adjusted OR 2.47; p = 0.01).
While a majority of RO and URO view existing prediction tools for localized PCa with some degree of confidence, a fifth of specialists reported not using any such tools in clinical practice. Lack of using such tools was associated with low utilization of AS for low-risk PCa.
World journal of urology. 2019 Jan 22 [Epub ahead of print]
Boris Gershman, Paul Maroni, Jon C Tilburt, Robert J Volk, Badrinath Konety, Charles L Bennett, Alexander Kutikov, Marc C Smaldone, Victor Chen, Simon P Kim
Department of Urology, Brown University, Providence, RI, USA., Division of Urology, University of Colorado, Denver, CO, USA., Biomedical Ethics Research Program, Division of General Internal Medicine, Department of Medicine and the Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA., Division of Cancer Prevention and Population Sciences, Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, TX, USA., Department of Urology, University of Minnesota, Minneapolis, MN, USA., College of Pharmacy, University of South Carolina, Columbia, SC, USA., Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Department of Urology , Loyola University Medical Center , Maywood, IL, USA., Division of Urology, University of Colorado, Denver, CO, USA. .