547 A NATIONAL SURVEY OF RADIATION ONCOLOGISTS AND UROLOGISTS ON ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER

Abstract

INTRODUCTION AND OBJECTIVES: While active surveillance (AS) is well recognized as an acceptable treatment strategy for low-risk prostate cancer (PC), the extent to which radiation oncologists and urologists perceive AS as effective and routinely recommend it to patients is unknown. Therefore, we sought to assess the attitudes and treatment recommendations for low-risk PC from a national survey of PC specialists. METHODS: A mail survey was sent to a population-based sample of 1,439 physicians in the U.S. from late 2011 and early 2012. Physicians were queried about their attitudes regarding AS and treatment recommendations for patients diagnosed with low-risk PC (PSA 10 ng/dl; T1c; and Gleason 6). Pearson Chi-square and multivariate logistic regression were used to test for differences in attitudes and treatment recommendations by physician demographics, compensation structure, primary place of employment, and specialty. RESULTS: Overall, 362 radiation oncologists and 360 urologists completed the survey for a 52% response rate. Most physicians reported that AS is effective for low-risk PC (72%) and stated that they were comfortable routinely recommending AS (69%). Urologists were more likely to agree that AS is effective (78% vs. 65%; p 0.001) and were comfortable recommending AS (75% vs. 62%; p 0.001) compared with radiation oncologists. Most physicians recommended radical prostatectomy (44%) or radiation therapy (32%), but fewer endorsed AS (22%) for low-risk disease. After adjusting for physician covariates, radiation oncologists were more likely to recommend radiation therapy (OR: 10.68; p 0.001), while urologists were more likely to recommend surgery (OR: 4.03; p 0.001) and AS (OR: 2.49; p 0.001) for low-risk PC. CONCLUSIONS: Although AS is widely viewed as effective by both radiation oncologists and urologists, most urologists continue to recommend surgery, while most radiation oncologists recommend radiation therapy. Our results may explain in part the relatively low contemporary use of AS in the U.S.