Do radiation oncologists and urologists endorse decision aids for active surveillance of low‐risk prostate cancer: Results from a national survey

4657 Background: 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; Gleason 6 in one of twelve cores). 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, 321 radiation oncologists and 322 urologists completed the survey for a 45% response rate. Most physicians reported that AS is effective for low-risk PC (71%) and stated that they were comfortable routinely recommending AS (67%). Urologists were more likely to agree that AS is effective (77% vs. 67%; p=0.005) and were comfortable recommending AS (74% vs. 61%; p=0.001) compared with radiation oncologists. Most physicians recommended radical prostatectomy (47%) or radiation therapy (32%), but fewer endorsed AS (21%) for low-risk disease. After adjusting for physician covariates, radiation oncologists were more likely to recommend radiation therapy (OR: 10.97; p<0.001), while urologists were more likely to recommend surgery (OR: 4.69; p<0.001) and AS (OR: 2.18; 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.

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Perspectives of health care professionals on active surveillance for the management of prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.81 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 81-81

Author(s):

Fred Saad ◽

Kittie Pang ◽

Margaret Fitch ◽

Veronique Ouellet ◽

Simone Chevalier ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Active Surveillance ◽

Health Care Providers ◽

Low Risk ◽

Care Providers ◽

Radiation Oncologists ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

81 Background: Active surveillance has gained widespread acceptance as a safe approach for patients with low risk prostate cancer. Despite presenting several advantages for both patients and the health care system, active surveillance is not adopted by all eligible patients. In this study, we evaluated the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods: We conducted five focus groups with a total of 48 health care providers (HCP) including family physicians, urologists, surgeons, radiation oncologists, fellows, and residents/medical students. These participants were all providing care for men with low risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of these HCP from academic hospitals in four Canadian provinces was captured. A content and theme analysis was performed on the verbatim transcripts to understand HCP decisions in proposing active surveillance and reveal the facilitators that affect the adherence to this approach. Results: Participants agreed that active surveillance is a suitable approach for low risk prostate cancer patients, but expressed concerns on the rapidly evolving and non-standardized guidelines for patient follow-up. They raised the need for additional tools to appropriately identify the patients best suited for active surveillance. Collaborations between urologists, radiation-oncologists, and medical oncologists were favoured, however, the role of general practitioners remained controversial once patients were referred to a specialist. Conclusions: Integration of more reliable tools and/or markers, and more specific guidelines for patient follow-up would help both patients and physicians in the decision-making for active surveillance.

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Active Surveillance Found Safe for Most Low-Risk Prostate Cancer Patients

Internal Medicine News ◽

10.1016/s1097-8690(08)70710-8 ◽

2008 ◽

Vol 41 (13) ◽

pp. 21

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Active Surveillance ◽

Low Risk ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

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‘Active Surveillance’ Proposed For Low-Risk Prostate Cancer

Family Practice News ◽

10.1016/s0300-7073(06)72814-6 ◽

2006 ◽

Vol 36 (6) ◽

pp. 7

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Low Risk ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

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Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽

10.3390/diagnostics11020355 ◽

2021 ◽

Vol 11 (2) ◽

pp. 355

Author(s):

Matteo Ferro ◽

Gennaro Musi ◽

Deliu Victor Matei ◽

Alessandro Francesco Mistretta ◽

Stefano Luzzago ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Inflammatory Markers ◽

Low Risk ◽

Inclusion Criteria ◽

Robotic Radical Prostatectomy ◽

Lymphocyte Ratio ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

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