Most patients with low-risk prostate cancer (PCa) who opt for active surveillance (AS) rather than therapy do so mainly because of the influence of the urologist who initially diagnosed the malignancy, a survey found.

Mark S. Soloway, MD, and associates at the University of Miami Miller School of Medicine, mailed a survey questionnaire to 185 men enrolled in AS at their university-based urologic oncology practice. The questionnaire asked subject whether they had been offered AS as an alternative to primary treatment by the urologist who had initially diagnosed their cancer.

A total of 105 men (57%) returned the survey. Physician influence was most frequently cited as the greatest contributor to their decision to choose AS, with 77 patients (73.3%) indicating that their doctor “thought it was a reasonable alternative,” according to a report in Urology (published online ahead of print). The number two reason, cited by 63 patients (60.0%), was that they “felt sure that I could still be cured with treatment if my cancer progressed.” Other reasons why men chose AS rather than therapy included concern about the side effects of incontinence (50 men or 47.6%) and erectile dysfunction (46 men or 43.5%).

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Dr. Soloway, Professor and Chairman Emeritus, Department of Urology, pointed out that his group’s criteria for active surveillance is quite strict. The criteria include low volume Gleason score 6, positive cores in no more than two biopsies, and less than 20% malignancy in each. He emphasized that a high proportion of patients (38 of the 105 men, or 36%) meeting these criteria were not offered this as an alternative to initial treatment by the urologist who made the initial diagnosis, despite guidelines and evidence supporting AS for low-risk PCa.

“Yet the reason to choose initial AS was related to the discussion with their doctor, indicating this is a reasonable initial alternative,” Dr. Soloway said.
Men on AS should be biopsied annually during the initial two to three years to ensure that the estimated tumor volume and grade are accurate, he said.

To date, not a single patient on AS for one year or more has developed metastatic PCa or failed therapy when the decision was made to proceed with treatment (15% of the AS patients), Dr. Soloway said.