Page 120 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Diagnosing Physician
Offer of AS. No study specifically examined how the involvement of the diagnosing physician
in the decisionmaking process might affect the offer of AS. However, one survey of 185 men
already on AS reported that AS was offered by 36 percent of the physicians who had made the
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initial diagnosis.

Acceptance of AS. No study or survey specifically addressed how the involvement of the
diagnosing physician might affect the acceptance of AS.

Adherence to AS. No study specifically examined how the involvement of the diagnosing
physician might affect the adherence to AS.

Consultant—2nd Opinion
Offer of AS. No study specifically examined how the involvement of a consulting physician for
a second opinion in the decisionmaking process might affect the offer of AS. However, a
description of interviews with 18 couples in which the men were recently diagnosed with early
stage prostate cancer and had not yet decided on a treatment reported that “the urologist had
recommended seeking a second opinion and indeed had offered to facilitate such a referral [for
several couples]. None followed through with this suggestion...The fact that the urologist [had
recommended seeking] a second opinion only further reinforced their trust and confidence....” 194
In an interview of 108 men in Australia with newly diagnosed localized prostate cancer,
concerning their urological consultation, 71 percent reported that their urologists discussed WW
(versus 92 percent for RP and 87 percent for RT). 192
One survey of 200 urologists querying their preferences for treatments for men with localized
prostate cancer and few comorbidities reported that 67 percent preferred RP, 29 percent preferred
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RT, and 4 percent preferred WW. The same study also surveyed 780 men with all stages of
prostate cancer and reported divergent opinions (patient versus physician) on whether treatment
options were discussed: 20 percent of the men versus 1 percent of the urologists felt that
treatment options were not discussed. It should be noted, however, that the urologists in the
survey were not necessarily the surveyed patients’ own urologists.
One survey of 238 men with newly diagnosed prostate cancer and their 25 urologists reported
on their office encounters. 182 Ninety-five men presented for an initial consultation, and 143 men
presented for a second opinion visit. The urologists recommended 0.52 more treatment options
(SE 0.19, P < 0.001) in the initial consultation setting than in the second opinion visit setting. For
men with low-risk disease, 25 percent of the urologists recommended AS and 77 percent
recommended RP in the initial consultation setting, but only 16 percent recommended AS and 91
percent recommended RP in the second opinion visit setting. The survey also reported a
discrepancy between what the physicians recommended and what the patients heard: in those
patients for whom the urologists recommended RP, 67 percent reported receiving the
recommendation; in those patients for whom the urologists recommended RT or ADT, only
about 25 percent of the patients reported receiving the recommendation.

Acceptance of AS. No study or survey specifically addressed how the involvement of a
c
consulting physician might affect the acceptance of AS.

c We are aware of one age-stratified analysis of 85,088 men with clinically localized disease identified from the
SEER-Medicare database which concluded that for all age groups, men who saw urologists either with or without

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