A majority of urologists and radiation oncologists are still not recommending active monitoring (“active surveillance”) as a first-line method for the management of patients with low-risk prostate cancer.
This information comes from a media release issued by the Mayo Clinic last Friday and referencing data presented by a Mayo Clinic-based research team at the annual meeting of the North Central Section of the American Urological Association just completed in Chicago.
We have not seen any of the details from this presentation by Dr. Simon Kim and his colleagues, so all we can tell readers is what appears in the media release, as follows:
- The research team surveyed 643 urologists and radiation oncologists.
- Only 21 percent of physicians studied recommended active surveillance for low-risk disease.
- 47 percent of physicians studied recommended surgery for men with low-risk disease
- 32 percent of physicians studied recommended radiation therapy for low-risk disease.
- Physician recommendations generally aligned with their area of expertise.
- Urologists generally recommended surgery.
- Radiation oncologists generally recommended radiation therapy.
We should note that we are missing a lot of information about this study, and so the results listed above should be interpreted with caution. For example:
- We have no idea what percentage of the 643 physicians surveyed actually responded to the survey (or whether 643 was the number of physicians who responded out of a much larger number to whom the survey was sent).
- We therefore do not know whether the 21 percent of physicians who said they did recommend active surveillance was 21/100 responders or 135/643 responders.
- We do not know what questions were actually asked of the participants, and how the questions were asked could profoundly impact individual responses.
It is not exactly surprising to learn that the majority of urologists and radiation oncologists still need to be convinced that active surveillance is a perfectly reasonable way to manage men with low-risk prostate cancer (and most particularly older men with limited life expectancies). Most urologists and radiation oncologists would probably say that we still only have data from case series on which to base decision making about this strategy (conveniently ignoring the fact that the same is true for treatment of low-risk patients with radiation therapy or surgery).
However, if we assume that the questions posed to the target audience for this survey were well framed, and that the number of actual responders was 643, then it is still distressing to see such a high proportion of the urology and radiation oncology communities unwilling to acknowledge the fact that the risks associated with immediate first-line treatment may well be outweighing the benefits — most particularly in older men with limited life expectancies.
“Our results may explain in part the relatively low use of active surveillance for low-risk prostate cancer in the United States,” Dr. Kim, a urologic oncologist at the Mayo Clinic, is quoted as saying in the media release.