Specialists who treat prostate cancer agree that active surveillance is an effective option for patients with low-risk prostate cancer; however, most are more likely to recommend the treatment provided by their own specialties, according to a recent study.
Investigators found that urologists and radiation oncologists are more likely to recommend surgery and radiation therapy, respectively. “Given the growing concerns about the overtreatment of prostate cancer, our study has important policy implications about possible barriers to promoting active surveillance and specialty biases about optimal treatment regarding localized prostate cancer,” comments Simon P. Kim, MD, MPH, of Yale School of Medicine, and lead author of the study (Medical Care. doi:10.1097/MLR.0000000000000155).
Kim and coauthors analyzed survey responses from 717 US urologists and radiation oncologists regarding their views on options for low-risk prostate cancer. The study focused on perceptions of using active surveillance as an initial approach.
The survey asked what treatment the specialists would recommend for a hypothetical 60-year-old man with low-risk prostate cancer. Only 22% of the physicians would recommend active surveillance. Instead, 45% percent would recommend surgery (radical prostatectomy) and 35% would recommend some form of radiation therapy.
Consistent with the research evidence, 72% of the specialists agreed that active surveillance is an effective alternative for men with low-risk prostate cancer. In addition, 80% agreed that active surveillance was underused in the United States.
In general, most respondents recommended the treatment provided by their specialty. Urologists were 4x more likely to recommend surgery compared with radiation oncologists. Urologists were also much less likely to recommend any form of radiation therapy. But they were more than twice as likely to recommend active surveillance compared with radiation oncologists, and doctors who worked in academic medical centers were also more likely to recommend active surveillance.
Most older men with early stage prostate cancer will not die of the disease because it typically progresses slowly. Active surveillance, in which patients are closely monitored for evidence of disease progression, can avoid surgery or radiation therapy. Both treatments include risk of complications and side effects and may not provide any real benefit for the patient.
The survey results support that physicians consider active surveillance as a reasonable initial treatment for appropriate patients with low-risk prostate cancer. Both groups of specialists acknowledge the growing concern about overtreatment of prostate cancer. But some key attitudinal barriers to active surveillance exists among prostate cancer specialists, Kim and colleagues reported.
Decision aids that provide men with evidence-based information on the advantages and disadvantages of treatment options can help patients be more involved in treatment decisions. Involving the patient’s primary care providers as part of the coordinated, multidisciplinary team may also provide a better balance between the risks and benefits of the different approaches, the investigators conclude.