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Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa.

Methods

In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS.

Results

We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent’s specialty.

Conclusions

Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.

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Funding

This study was supported by a career development award for Dr. Simon Kim from the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO).

Author information

Authors and Affiliations

  1. Center for Quality and Outcomes, Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Simon P. Kim

  2. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA

    Simon P. Kim & Neal J. Meropol

  3. Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA

    Simon P. Kim, Cary P. Gross & James B. Yu

  4. Department of Medicine, Yale University, New Haven, CT, USA

    Cary P. Gross

  5. Division of Health Policy and Research, Mayo Clinic, Rochester, MN, USA

    Nilay D. Shah

  6. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Nilay D. Shah

  7. Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Jon. C. Tilburt

  8. Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA

    Jon. C. Tilburt

  9. Department of Urology, University of Minnesota, Minneapolis, MN, USA

    Badrinath Konety & Christopher J. Weight

  10. Division of Urology, University of Texas Medical Branch, Galveston, TX, USA

    Stephen B. Williams

  11. Department of Radiation Oncology, Yale University, New Haven, CT, USA

    James B. Yu

  12. Department of Radiation Oncology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA

    Aryavarta M. S. Kumar

  13. Flatiron Health, New York, NY, USA

    Neal J. Meropol

Authors
  1. Simon P. Kim
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  2. Cary P. Gross
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  3. Nilay D. Shah
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  4. Jon. C. Tilburt
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  5. Badrinath Konety
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  7. Christopher J. Weight
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  8. James B. Yu
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  9. Aryavarta M. S. Kumar
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  10. Neal J. Meropol
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Corresponding author

Correspondence to Simon P. Kim.

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Kim, S.P., Gross, C.P., Shah, N.D. 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 26, 660–668 (2019). https://doi.org/10.1245/s10434-018-6863-1

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  • DOI: https://doi.org/10.1245/s10434-018-6863-1

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