Active surveillance for low-risk prostate cancer: knowledge, acceptance and practice among urologists

• Published in: Prostate cancer and prostatic diseases Vol. 15; no. 2; pp. 177 - 181
• Main Authors: Gorin, M A, Eldefrawy, A, Ekwenna, O, Soloway, M S
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2012; Nature Publishing Group
• Subjects: Biomedicine; Biopsy; Biopsy, Needle; Cancer; Cancer Research; Care and treatment; Comparative studies; Criteria; Diagnosis; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Health risks; Humans; Immune system; Male; original-article; Patients; Polls & surveys; Population Surveillance - methods; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Reproductive Medicine; Risk acceptance; Strategy; Surveillance; Surveys; Surveys and Questionnaires; Testing; Tumors; Urologists; Urology; United States; survey; active surveillance; watchful waiting
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/pcan.2011.57

Background: This study aimed to survey urologists regarding their knowledge, acceptance and practice of active surveillance (AS) for low-risk prostate cancer. Methods: An email-based survey was distributed to 4987 urologists. Respondents were surveyed regarding their knowledge and acceptance of AS. Those who felt AS was a reasonable strategy were asked their opinions on the criteria for AS enrollment and the details of their practice of AS. Respondents who felt AS was not a reasonable alternative were queried as to the reasons why. Results: A total of 425 (9%) urologists successfully completed the survey and 387 (91%) were both familiar with AS and aware that AS differed from watchful waiting. Of this latter group, 370 (96%) respondents felt AS was a reasonable management strategy, 95% of whom manage patients with this approach. A minority of respondents (6%) felt that patients with a PSA>10 ng ml −1 were eligible for AS. Further, most participants (74%) felt that patients required a Gleason score ⩽6. There was little agreement on the timing of follow-up biopsies. Respondents who objected to AS were most commonly concerned with missing an opportunity for curative treatment (76%) and the risk of tumor undergrading (65%). Conclusions: The majority of participants were knowledgeable and accepting of AS. Respondents were in relative agreement regarding the PSA and Gleason score criteria for AS enrollment. In contrast, there was a lack of agreement on the timing of follow-up biopsies. In the future, comparative studies are required to determine the optimal enrollment criteria and follow-up protocol for patients managed with AS.