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

Background: 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. Objective: To determine whether AS for PCa is becoming readily accepted by PCa specialists in the USA. Design, setting, and participants: 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. Outcome measurements and statistical analysis: 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. Results and limitations: 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 8 ng/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. Conclusions: 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. Patient summary: 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. With utilization of active surveillance (AS) for intermediate-risk prostate cancer remaining controversial, specialists were surveyed about treatment recommendations and perceptions of efficacy. We found that most specialists do not believe that AS is effective, feel comfortable recommending it, or select it as an option for younger patients.