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

Simon P. Kim, Jon C Tilburt, Nilay D Shah, James B. Yu, Badrinath Konety, Paul L. Nguyen, Robert Abouassaly, Stephen B. Williams, Cary P. Gross

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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. While active surveillance (AS) represents the preferred initial strategy for low-risk prostate cancer (PCa), understanding the barriers to its use is essential. In our national survey, recommendations of AS from case presentations varied by clinical factors and physician specialty. Fewer specialists recommended AS for younger age, higher prostate-specific antigen, or greater number of positive cores of Gleason 6 PCa.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
StatePublished - Jan 1 2019



  • Active surveillance
  • Physician bias
  • Prostate cancer
  • Survey

ASJC Scopus subject areas

  • Oncology
  • Urology

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