Recommendations of Active Surveillance for Intermediate-risk Prostate Cancer: Results from a National Survey of Radiation Oncologists and Urologists.

While active surveillance (AS) for intermediate-risk prostate cancer (PCa) remains controversial, perceptions of AS and treatment recommendations among PCa specialists are largely unknown. Thus, we performed a national survey of radiation oncologists (ROs) and urologists (UROs) to elicit attitudes and AS recommendations for intermediate-risk PCa.

To determine whether AS for PCa is becoming readily accepted by PCa specialists in the USA.

From January to July 2017, we conducted a national survey of 915 ROs and 940 UROs on perceptions of AS and its use among patients with intermediate-risk PCa.

Perceived effectiveness and comfort with AS and recommendation of AS from case presentations represented the primary outcomes. Pearson chi-square and multivariable logistic regression analyses were used to identify physician characteristics associated with primary outcomes.

Overall, the response rate was 37.3% (n=692) and was similar for ROs and UROs (35.7% vs 38.7%; p=0.18). For intermediate-risk PCa, both UROs and ROs expressed limited favorable views that AS is effective (39.8% vs 33.0%; p=0.06) and felt comfortable recommending it (37.6% vs 25.9%; p=0.001). From clinical scenarios, both specialties infrequently recommended AS for a healthy patient diagnosed with intermediate-risk PCa. For a healthy 55-yr-old patient with PSA of 8ng/ml and Gleason 3+4 PCa, few ROs and UROs recommended AS (2.8% vs 4.3%; adjusted odds ratio [AOR] 0.42; p=0.12). AS was more likely to be recommended equally by ROs and UROs for a healthy 75-yr-old with the same clinicopathologic characteristics (29.0% vs 35.4%; AOR 0.68; p=0.09). Limitations include a modest response rate for our survey.

Our national survey revealed that many ROs and UROs do not believe that AS is effective or feel comfortable recommending it or selecting it as an option for younger patients with intermediate-risk PCa.

We performed a national survey of radiation oncologists and urologists to assess attitudes regarding active surveillance (AS) and its use among patients with intermediate-risk prostate cancer. Our study demonstrates that radiation oncologists and urologists are not yet comfortable with recommending AS and rarely endorse its use for younger patients.

European urology oncology. 2018 Aug 31 [Epub]

Simon P Kim, Nilay D Shah, Neal J Meropol, Jon C Tilburt, Paul L Nguyen, James B Yu, Robert Abouassaly, Albert Kim, Cary P Gross

Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT, USA. Electronic address: ., Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA., Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; FlatIron Health, New York, NY, USA., Department of Medicine, Mayo Clinic, Rochester, MN, USA., Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT, USA; Department of Radiation Oncology, Yale University, New Haven, CT, USA., Department of Urology, Louis Stokes VA Medical Center, Cleveland, OH, USA; Glickman Urological and Nephrology Institute, Cleveland Clinic, Cleveland, OH, USA., Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT, USA; Department of Medicine, Yale University, New Haven, CT, USA.

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