A poster to be presented at the upcoming ASCO annual meeting gives us some insights into the actual behaviors of physicians and their patients regarding the use of active surveillance today in the “real world” of clinical practice (as opposed to clinical trials and case series at academic medical centers).
The abstract of the poster to be presented at ASCO by Kim et al. is based on data from a survey sent to > 1,400 urologists and radiation oncologists between late 2011 and early 2012. These physicians were asked to provide information about their views on active surveillance as a management strategy for men with low-risk or very low-risk prostate cancer defined as PSA < 10 ng/ml, clinical stage T1c, Gleason 6 cancer in only 1/12 biopsy cores. (Note that this is a lower definition of “low risk” than that recommended by the National Comprehensive Cancer Network.)
Here are the results of the survey as presented by Kim et al.:
- The survey was sent (by mail ) to a population-based sample of 1,439 US-based urologists and radiation oncologists.
- 643/1,439 physicians (44.7 percent) completed and returned the survey, including
- 321 radiation oncologists
- 322 urologists
- 71 percent of the respondents stated that active surveillance is an effective management strategy for low-risk prostate cancer.
- 67 percent of the respondents stated that they were comfortable routinely recommending active surveillance.
- Urologists were more likely to agree that active surveillance is effective than radiation oncologists (77 vs. 67 percent; p = 0.005).
- Urologists were more comfortable recommending active surveillance than radiation oncologists (74 vs. 61 percent; p = 0.001).
- Most physicians actually recommended either radical prostatectomy (47 percent) or radiation therapy (32 percent) for treatment of low-risk disease.
- Only 21 percent of physicians actually recommended active surveillance.
- Radiation oncologists were more likely to recommend radiation therapy (OR = 10.97; p < 0.001).
- Urologists were more likely to recommend surgery (OR = 4.69; p < 0.001) and active surveillance (OR = 2.18; p = 0.001).
The results of this survey appear to confirm a widespread perception that, despite a theoretical appreciation of the value of active surveillance, neither the urology community nor the radiation oncology community, as yet, are fully committed to practicing what is recommended in clinical guidelines and justified by the available clinical data.