Urologists’ Attitudes About Active Surveillance for Low-Risk Prostate Cancer: Survey Findings
Posted: Wednesday, April 7, 2021
A cross-sectional survey of urologists showed that most believe that active surveillance of patients with low-risk prostate cancer is both effective and underused. Active surveillance specifically consists of close monitoring for disease progression through serial prostate-specific antigen testing, digital rectal examinations, prostate imaging, and prostate biopsy, with curative treatment offered for significant cancer progression. The survey results were published in Urology by Michael Goodman, MD, MPH, of Emory University, Atlanta, and colleagues.
“These findings indicate targeted educational efforts in the United States are needed to influence urologists toward greater acceptance of active surveillance,” concluded the authors.
The authors adapted a survey from the Cancer Care Outcomes Research and Surveillance Consortium surgeon’s survey to understand predictors of urologists’ treatment recommendations. These surveys were distributed to 621 urologists in Michigan and Georgia between 2015 and 2017.
Of the 225 respondents, 65% were from Michigan and 35%, from Georgia. Nearly all (99%) reported they provided active surveillance; 97% discussed and 61% offered active surveillance to all of their low-risk patients. In addition, 97% of urologists believed that active surveillance is effective, and 90% believed it is underused. Many (80%) reported that curative therapy with surgery and radiation is likely overused in the United States. Of note, 79% of the respondents agreed that Black men are more likely to have aggressive low-risk disease; however, 89% reported feeling comfortable recommending active surveillance to Black men.
The study authors also reported that urologists in Michigan were 57% more likely to recommend active surveillance, compared with those in Georgia. Urologists who had practiced for more years or believed there was a survival benefit to prostatectomy were less likely to recommend active surveillance. Patients who were fearful of cancer progression were less likely to receive active surveillance, and this seemed to have a larger effect on White patients than Black patients (odds ratio = 8.3 vs. 7.1).
Disclosure: The study authors reported no conflicts of interest.