Nationwide analysis of genitourinary expert opinions on active surveillance for localized prostate cancer.

Abstract

29 Background: The ProtecT trial has provided Level 1 evidence supporting active surveillance for prostate cancer patients with low-risk and intermediate risk disease. The impact of these findings on the opinions of North American genitourinary (GU) experts regarding the role of active surveillance for these patients has not been previously examined. Methods: A survey was distributed to 88 practicing North American GU physicians serving on decision-making committees of cooperative group research organizations. Questions pertained to knowledge about and personal opinions on the role of active surveillance in patients with low-risk and intermediate-risk (Gleason 3+4) disease. Opinions regarding active surveillance were correlated with practice patterns using Fisher’s exact test. Results: Analysis was conducted on 42 radiation oncologist respondents. Forty percent have been in practice for 20+ years; 90% practice at an academic center. Forty-five percent see 20+ patients/month in consultation. More than 95% recommended active surveillance for Gleason 6 disease, while only 17% recommended active surveillance for Gleason 3+4 disease. There were no significant demographic differences between supporters or opponents of active surveillance regarding monthly patient volume, practice type, self-identification as an expert brachytherapist, belief in advanced imaging techniques, or preferred default EBRT dose/fractionation for low-risk or intermediate-risk disease. However, opposition to active surveillance for Gleason 3+4 disease approached significance for experts having practiced 10+ years versus < 10 years (p = 0.085). Conclusions: Active surveillance is well-regarded among North American GU experts for low-risk but not intermediate-risk prostate cancer, despite the results of the ProtecT trial providing Level 1 evidentiary support for active surveillance in both risk groups. There were no significant differences between experts supporting versus opposing active surveillance for either low-risk or intermediate-risk disease. These preferences may affect the design of future clinical studies, influencing the adoption of active surveillance in North American clinical practice.