PRP057: Comparisons of Perceptions of Active Surveillance by Urologists and Radiation Oncologists for Low-risk Prostate Cancer

Jinping Xu, MD, MS; Cathryn Bock, PhD, MPH; Justin Woo, BS

Abstract

Context: Due to concerns about overtreatment, practice guidelines recommend active surveillance (AS) as the preferred option for low-risk prostate cancer (LPC). Limited data are available as to specialists’ perceptions and recommendations of AS. Objective: To assess and contrast opinions of urologists and radiation oncologists about their perceptions of AS and treatment recommendations for LPC. Design: Cross-sectional survey. Setting: Population-based survey. Population studied: Practicing specialists taking care of prostate cancer patients in two locations (Michigan and Georgia) in the US. Instrument: Mailed or online survey. Outcome Measures: Perceptions and experiences of AS, and treatment recommendations for LPC. Results: Overall, 225 practicing urologists and 97 radiation oncologists completed the survey. Most specialists were White (78%), practiced in a single specialty group (55%), and had a mean age of 52 years (SD = 12, range 29-82). More urologists were male (96% vs 85%, p=0.002), involved in teaching (67% vs 54%, p=0.03) and had been in practice longer (20 vs 17 years, p = 0.02). More urologists also reported their pay were productivity-based comparing to radiation oncologists (59% vs 38%, p=0.004). Both specialists reported that AS is effective (96% vs 89%, p=0.02) and over 90% provided AS to eligible patients (99% vs. 95%, p=0.03), and discussed AS with all of their low-risk patients (98% vs 91%, p=0.009, urologists vs radiation oncologists, respectively). Most urologists and half of radiation oncologists reported offering AS to all of their low-risk patients (61% vs 50%, p=0.06). More urologists endorsed that Black men are more likely to have an aggressive LPC (79% vs 61%, p=0.002). For men with low-risk prostate cancer and more than 10-year life expectancy, more urologists believed that prostatectomy (75% vs 45%), external radiation (66% vs 43%), and brachytherapy (65% vs 47%) has survival benefit comparing to radiation oncologists (all p<0.01). There are no significant differences in specialists’ AS perceptions between the two geographical locations. Conclusions: Based on this study, while urologists and radiation oncologists do agree on a variety of issues regarding AS and treatment recommendation for low-risk prostate cancer, specialists differ in some of their AS perceptions and practices.

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