Survey: Docs prefer aggressive treatments for low-risk prostate cancer

by Brendon Nafziger, DOTmed News Associate Editor | October 15, 2012
Men with low-risk prostate cancer are often better off watching and waiting — known as active surveillance — than going under the knife or getting treated with radiation therapy. But a new survey of more than 700 urologists and radiation oncologists suggests that doctors, at least in a hypothetical scenario, are more likely to recommend aggressive treatments.

Perhaps, unsurprisingly, they're also more eager to suggest treatments that fall under their specialty, with most urologists calling for surgical removal of the prostate and most radiation oncologists pushing for radiation therapy, according to the survey, which was shared Friday at the North Central Section of the American Urological Association's annual meeting in Chicago.

The findings "may provide some explanation of the low contemporary use of active surveillance in the U.S.," write the researchers in their Powerpoint presentation. The study, among the first of its kind to gauge urologists' and radiation oncologists' attitudes to active surveillance, was led by Dr. Simon P. Kim, a urologic oncologist at Mayo Clinic.

The survey, mailed to doctors under American Medical Association auspices in late 2011 and early 2012, asked respondents to imagine the case of a 65-year-old man with a Gleason score of 6 in one of 12 biopsy samples. A score of 7 or under is generally considered less aggressive.

While nearly three-quarters of the respondents said active surveillance was an effective treatment option, and the majority (68 percent) said they were comfortable recommending it to their patients, few chose the watch-and-wait approach in this scenario.

According to the survey, only 16.5 percent of radiation oncologists, and 27.8 percent of urologists, prescribed active surveillance. Most urologists, 61.6 percent, recommended radical prostatectomy, while most radiation oncologists, 55.6 percent, recommended radiation therapy.

Only a minority of specialists recommended the other discipline's treatment. Just 10.3 percent of urologists recommended radiation therapy, and 27.9 percent of radiation oncologists recommended surgery, according to the survey.

Still, the researchers pointed out that their survey, which had 722 responses, had some limitations, including that the response to the questionnaire might not accurately reflect clinical practice.

The study is "A National Survey of Radiation Oncologists and Urologists on Active Surveillance for Low-Risk Prostate Cancer."

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