Page 403 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Appendix Table C3.1 Studies on offer, acceptance, and adherence of active surveillance (continued)
Factors examined Author Study approach AS/WW definitions Findings Issues
Year
PMID
Offer of WW by Fowler 188 Survey (“pretested”) returned by WW = “expectant • ~10-20% of urologists and • Surveys sent to
MD 2000 504 urologists and 559 radiation management” radiation oncologists would urologists and radiation
10866869 oncologists; random sample of recommend WW if PSA ~5 oncologists were
urologists (response rate 64%) and ng/mL and Gleason score 4 or 5 somewhat different
radiation oncologists (response rate (Scenario was for a 65 yr man in • Survey response rate
76%) in the AMA Registry of good health, with negative DRE 64% (urologists) & 76%
Physicians who practiced at least and no evidence of nonlocalized (radiation oncologists)
20 h per week disease).
• Almost no (0-1%) would
recommend WW for those with
higher PSA or Gleason scores.
• No difference between
urologists and radiation
oncologists.
Offer of AS by Gorin 122 Survey of 185 men already on AS DRE + PSA q 3-4 mo • AS offered by the MD who • Non-validated survey
MD; 2011 (unclear selection procedure) in a for the first 2 yr, then q had made the initial dx in 38/105 instrument
acceptance of 21215429 university-based urologic oncology 6 mo; annual bx; (36%) • Population already
AS by patient practice (105 of 185, 57% sooner if significant • MD influence had the decided to enroll in AS
responded); pts were asked rise in PSA or change greatest impact on choosing AS • Had been on AS
whether the urologist who dx’d the in DRE; treatment (73%) varying times (some >2
cancer offered AS as a primary encouraged for ↑ • Concerns for incontinence yrs)
treatment alternative tumor volume, (48%) and erectile dysfunction • Survey response rate
Gleason ≥7 or >2 (44%) also reasons for choosing 57%
positive cores AS
Patient factors Holmboe 187 Open-ended interview of 102 men WW (not explicitly • 30% men stated that • Small sample size
affecting 2000 with localized disease who had provided) physician recommendation • Unclear details
acceptance 11089712 made a treatment decision but had influenced their treatment concerning WW
not yet received the treatment (88% decision
RP, RT or ADT; 12% WW); sample • 59% of patients discussed
obtained from 128 consecutive men WW (presumably with their
with newly dx’d localized disease, physicians)
pts drawn from a university, a VA, • Fear of consequences most
and 2 community urology practices common reason (64%) for not
selecting WW; some of the
others were perceived elevated
risk because of  PSA or Gleason
(12%); physician (12%) and/or
family (4%) against WW

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