Active Surveillance Recommendations Lagging

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CHICAGO—Most urologists and radiation oncologists regard active surveillance as an effective strategy for managing low-risk prostate cancer (PCa), but only a minority of them recommend it, a survey found.

Study results, which were presented at the annual meeting of the North Central Section of the American Urological Association, showed that 47% recommended surgery, 32% recommended radiation therapy, and only 21% recommended active surveillance for low-risk PCa.

Overall, physician recommendations aligned with their speciality: Most urologists recommended surgery and most radiation oncologists recommended radiation therapy. After adjusting for physician covariates, radiation oncologists were 10.7 times more likely to recommend radiation therapy than surgery and urologists were four times more likely to recommend surgery than radiation therapy. They also were 2.5 times more likely to recommend active surveillance.

“Our results may explain in part the relatively low use of active surveillance for low-risk prostate cancer in the United States,” said lead investigator Simon Kim, MD, MPH, a urologic oncology fellow at Mayo Clinic in Rochester, Minn.

The extent to which radiation oncologists and urologists perceive active surveillance as effective and recommend it routinely to patients has not been well studied, Dr. Kim said. He and his colleagues assessed the attitudes and treatment recommendations for low-risk PCa from a national survey of PCa specialists. For this investigation, a survey was mailed to a population-based sample of 1,494 physicians in the United States from late 2011 to early 2012. All the physicians were asked how they view active surveillance as well as what their treatment recommendations were for patients diagnosed with low-risk PCa, which was defined as a PSA level below 10 ng/dL, clinical stage T1c, and a Gleason of 6 in one of 12 cores.

A total of 362 radiation oncologists and 360 urologists completed the survey, for a response rate of 52%. Seventy-two percent of respondents said they thought active surveillance was effective for low-risk PCa and 69% said they were comfortable routinely recommending this approach.

The specialists showed some significant differences, however. Urologists were more likely than radiation oncologists to agree that active surveillance was effective (78% vs. 65%) and more urologists than radiation oncologists were comfortable recommending it (75% vs. 62%).

“Treatment choices for low-risk prostate cancer also reflect patient preferences, which may in part explain the higher rates of surgery and radiation therapy rather than active surveillance in the treatment recommendations for low-risk prostate cancer,” Dr. Kim told Renal & Urology News.  The results of the study, which was funded by the Informed Medical Decisions Foundation, may help partially explain the relatively low contemporary use of active surveillance in the United States.

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