Advertisement

Urologists’ Perceptions of Active Surveillance and Their Recommendations for Low-risk Prostate Cancer Patients

Published:January 18, 2021DOI:https://doi.org/10.1016/j.urology.2020.12.037

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mohler J
        • Bahnson RR
        • Boston B
        • et al.
        NCCN clinical practice guidelines in oncology: prostate cancer.
        J Natl Compr Canc Netw. 2010; 8: 162-200
        • NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)
        Prostate Cancer.
        2016 (Accessed 16 May, 2020)
        • Womble PR
        • Montie JE
        • Ye Z
        • et al.
        Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer.
        Eur Urol. 2015; 67: 44-50
        • Cooperberg MR
        • Carroll PR.
        Trends in management for patients with localized prostate cancer, 1990-2013.
        JAMA. 2015; 314: 80-82
        • DeSantis CE
        • Miller KD
        • Goding Sauer A
        • Jemal A
        • Siegel RL
        Cancer statistics for African Americans, 2019.
        CA Cancer J Clin. 2019; 69: 211-233
        • Deka R
        • Courtney PT
        • Parsons JK
        • et al.
        Association between African American Race and Clinical Outcomes in men treated for low-risk prostate cancer with active surveillance.
        JAMA. 2020; 324: 1747-1754
        • Schenk JM
        • Newcomb LF
        • Zheng Y
        • et al.
        African American Race is not associated with risk of reclassification during active surveillance: results from the canary prostate cancer active surveillance study.
        J Urol. 2020; 203: 727-733
        • Xu J
        • Janisse J
        • Ruterbusch J
        • Ager J
        • Schwartz KL.
        Racial differences in treatment decision-making for men with clinically localized prostate cancer: a population-based study.
        J Racial Ethn Health Disparities. 2016; 3: 35-45
        • Hoffman KE
        • Niu J
        • Shen Y
        • et al.
        Physician variation in management of low-risk prostate cancer: a population-based cohort study.
        JAMA Intern Med. 2014; 174: 1450-1459
        • Auffenberg GB
        • Lane BR
        • Linsell S
        • Cher ML
        • Miller DC.
        Practice- vs physician-level variation in use of active surveillance for men with low-risk prostate cancer: implications for collaborative quality improvement.
        JAMA Surg. 2017; 152: 978-980
        • Kim SP
        • Tilburt JC
        • Shah ND
        • et al.
        A National Survey of radiation oncologists and urologists on perceived attitudes and recommendations of active surveillance for low-risk prostate cancer.
        Clin Genitourin Cancer. 2019; 17: e472-e481
        • Kim SP
        • Gross CP
        • Shah ND
        • et al.
        Perceptions of barriers towards active surveillance for low-risk prostate cancer: results from a National Survey of Radiation Oncologists and Urologists.
        Ann Surg Oncol. 2019; 26: 660-668
        • Kim SP
        • Gross CP
        • Nguyen PL
        • et al.
        Perceptions of active surveillance and treatment recommendations for low-risk prostate cancer: results from a National Survey of Radiation Oncologists and Urologists.
        Med Care. 2014; 52: 579-585
        • Ayanian JZ
        • Chrischilles EA
        • Fletcher RH
        • et al.
        Understanding cancer treatment and outcomes: the Cancer Care Outcomes Research and Surveillance Consortium.
        J Clin Oncol. 2004; 22: 2992-2996
        • Xu J
        • Dailey RK
        • Eggly S
        • Neale AV
        • Schwartz KL.
        Men's perspectives on selecting their prostate cancer treatment.
        J Natl Med Assoc. 2011; 103: 468-478
        • Xu J
        • Neale AV
        • Dailey RK
        • Eggly S
        • Schwartz KL.
        Patient perspective on watchful waiting/active surveillance for localized prostate cancer.
        J Am Board Fam Med. 2012; 25: 763-770
        • Mallapareddi A
        • Ruterbusch J
        • Reamer E
        • Eggly S
        • Xu J.
        Active surveillance for low-risk localized prostate cancer: what do men and their partners think?.
        Fam Pract. 2017; 34: 90-97
        • Davison BJ
        • Breckon E.
        Factors influencing treatment decision making and information preferences of prostate cancer patients on active surveillance.
        Patient Educ Couns. 2012; 87: 369-374
        • Fung-Kee-Fung SD
        • Porten SP
        • Meng MV
        • Kuettel M.
        The role of active surveillance in the management of prostate cancer.
        J Natl Compr Canc Netw. 2013; 11: 183-187
        • Cabana MD
        • Rand CS
        • Powe NR
        • et al.
        Why don't physicians follow clinical practice guidelines? A framework for improvement.
        JAMA. 1999; 282: 1458-1465
        • McKinlay JB
        • Link CL
        • Freund KM
        • Marceau LD
        • O'Donnell AB
        • Lutfey KL
        Sources of variation in physician adherence with clinical guidelines: results from a factorial experiment.
        J Gen Intern Med. 2007; 22: 289-296
        • Mahran A
        • Turk A
        • Buzzy C
        • et al.
        Younger men with prostate cancer have lower risk of upgrading while on active surveillance: a meta-analysis and systematic review of the literature.
        Urology. 2018; 121: 11-18
        • Leapman MS
        • Cowan JE
        • Nguyen HG
        • et al.
        Active surveillance in younger men with prostate cancer.
        J Clin Oncol. 2017; 35: 1898-1904
        • Hoffman KE
        • Penson DF
        • Zhao Z
        • et al.
        Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer.
        JAMA. 2020; 323: 149-163
        • Butler S
        • Muralidhar V
        • Chavez J
        • et al.
        Active surveillance for low-risk prostate cancer in black patients.
        N Engl J Med. 2019; 380: 2070-2072
        • Tyson MD
        • Alvarez J
        • Koyama T
        • et al.
        Racial variation in patient-reported outcomes following treatment for localized prostate cancer: results from the CEASAR study.
        Eur Urol. 2017; 72: 307-314
        • Scherr KA
        • Fagerlin A
        • Hofer T
        • et al.
        Physician recommendations trump patient preferences in prostate cancer treatment decisions.
        Med Decis Making. 2017; 37: 56-69
        • Goldstein MK
        • Lavori P
        • Coleman R
        • Advani A
        • Hoffman BB.
        Improving adherence to guidelines for hypertension drug prescribing: cluster-randomized controlled trial of general versus patient-specific recommendations.
        Am J Manag Care. 2005; 11: 677-685
        • Cher ML
        • Dhir A
        • Auffenberg GB
        • et al.
        Appropriateness criteria for active surveillance of prostate cancer.
        J Urol. 2017; 197: 67-74
        • Ginsburg KB
        • Montie JE
        • Cher ML.
        Defining quality metrics for active surveillance: the MUSIC experience.
        J Urol. 2020; (in press)