ABSTRACT
Objective
To assess practicing urologists’ attitudes and perceptions of active surveillance
(AS) and other treatment options for low-risk prostate cancer.
Methods
This was a cross-sectional survey of urologists practicing in Michigan and Georgia.
Urologists were asked about perceptions and practices pertaining to AS.
Results
Overall, 225 urologists completed the survey; 147 (65%) were from Michigan and 78
(35%) were from Georgia. Most urologists reported they provided (99%), discussed (97%),
and offered (61%) AS to all of their low-risk patients. Most believed AS is effective
(97%) and underused (90%), while 80% agreed that curative therapy (surgery, radiation)
is overused in the United States. Although most (79%) endorse that Black men are more
likely to have aggressive low-risk disease, 89% reported feeling comfortable recommending
AS to Black men. In multivariable analysis, significant provider-related predictors
of AS recommendation were practice location, number of years in practice, beliefs
pertaining to survival benefit of prostatectomy and effectiveness of AS, and expectation
that patients are not interested in AS. The patient characteristics of race, age,
life expectancy, fear of cancer progression, and fear of treatment side effects were
also significant predictors of AS recommendations.
Conclusion
Most urologists surveyed stated that AS is effective and underused for low-risk prostate
cancer . Overall, urologists are much less likely to recommend AS to younger men and
slightly less to Black men. AS recommendations varied by practice location and by
years in practice. These findings indicate targeted educational efforts in the US
are needed to influence urologists toward greater acceptance of AS.
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Article info
Publication history
Published online: January 18, 2021
Accepted:
December 20,
2020
Received:
September 18,
2020
Footnotes
Funding Support: This study is funded by American Cancer Society (Grant number: RSG-13-164-01-CPPB).
Prior presentation: Partial results presented at 2019 Annual North America Primary Care Research Group (NAPCRG) Meeting, November 16-20, 2019, Toronto, Ontario, Canada.
Conflict of Interest Disclaimers: The investigators had no conflicts of interest in conducting the study or writing the manuscript. The principal investigator (JX) was the recipient of grant funding from American Cancer Society, and was involved in study design, data collection and analysis, interpreting data, and writing this report. Investigators had full access to the analytic dataset and accept full responsibility for the integrity of the data and the accuracy of the data analysis.
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