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Clin Genitourin Cancer. 2019 Feb 7. pii: S1558-7673(18)30637-2. doi: 10.1016/j.clgc.2019.01.008. [Epub ahead of print]

A National Survey of Radiation Oncologists and Urologists on Perceived Attitudes and Recommendations of Active Surveillance for Low-Risk Prostate Cancer.

Author information

1
Division of Urology, University of Colorado-Denver, Denver, CO; Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT. Electronic address: simon.kim@ucdenver.edu.
2
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN; Division of Bioethics, Mayo Clinic, Rochester, MN; Department of Medicine, Mayo Clinic, Rochester, MN.
3
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN; Division of Health Policy & Research, Mayo Clinic, Rochester, MN.
4
Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT; Department of Radiation Oncology, Yale University, New Haven, CT.
5
Department of Urology, University of Minnesota, Minneapolis, MN.
6
Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
7
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH; Louis Stokes, Cleveland VA Medical Center, Cleveland, OH.
8
University of Texas Medical Branch, Division of Urology, Galveston, TX.
9
Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT; Department of Medicine, Yale University, New Haven, CT.

Abstract

BACKGROUND:

Clinical factors and barriers affecting adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. We performed a national survey of radiation oncologists (RO) and urologists (URO) about the perceptions and recommendations of AS for low-risk PCa.

MATERIALS AND METHODS:

In 2017, we surveyed 915 RO and 940 URO about AS for low-risk PCa in the United States. Survey items queried respondents about their attitudes toward AS and recommendations of AS for low-risk PCa. Pearson chi-square and multivariable logistic regression identified clinical and physician factors related toward AS for low-risk PCa.

RESULTS:

Overall, the response rate was 37.3% (n = 691) and was similar for RO and URO (35.7% vs. 38.7%; P = .18). RO were less likely to consider AS effective for low-risk PCa (86.5% vs. 92.0%; P = .04) and more likely to rate higher patient anxiety on AS (49.5% vs. 29.5%; P < .001) than URO. Recommendations of AS varied modestly on the basis of age, prostate-specific antigen (PSA), and number of cores positive for Gleason 3 + 3 PCa. For a 55-year-old man with PSA 8 with 6 cores of Gleason 6 PCa, both RO and URO infrequently recommended AS (4.4% vs. 5.2%; adjusted odds ratio = 0.6; P = .28). For a 75-year-old patient with PSA 4 with 2 cores of Gleason 6 PCa, URO and RO most often recommended AS (89.6% vs. 83.4%; adjusted odds ratio = 0.5; P = .07).

CONCLUSION:

RO and URO consider AS to be effective in the clinical management of low-risk PCa, but this varies by clinical and physician factors.

KEYWORDS:

Active surveillance; Physician bias; Prostate cancer; Survey

PMID:
30827923
DOI:
10.1016/j.clgc.2019.01.008

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