With the current controversy on prostate cancer screening and PSA (prostate-specific antigen) testing, a trend appears to be developing away from aggressive surgical treatment for early-stage localized prostate cancer.

Today, most urologists and radiation oncologists regard watchful waiting or active surveillance as an effective strategy for managing low-risk prostate cancer. Oddly though, only a minority of urologists currently recommend it to their patients. Remember, urologists are basically surgeons.

A study presented at the North Central Section of the American Urological Association showed that 47 percent of urologists recommended surgery, 32 percent recommended radiation therapy, and only 21 percent recommended active surveillance for low-risk prostate cancer.

Not surprisingly, the physicians’ recommendations aligned with their specialties: Most urologists recommended surgery, and most radiation oncologists recommended radiation therapy. Oncologists were 10.7 times more likely to recommend radiation therapy than surgery, and urologists were 4 times more likely to recommend surgery than radiation.

Dr. Simon Kim, a urologic oncology fellow at Mayo Clinic in Rochester, Minnesota, assessed the attitudes and treatment recommendations for low-risk prostate cancer from a national survey of prostate cancer specialists. Between 2011 and early 2012, a survey was mailed to 1,494 physicians in the United States who are active in the treatment of prostate cancer. All of the surgeons were asked how they view active surveillance as well as what their treatment recommendations were for patients diagnosed with low-risk prostate cancer. Of the 722 physicians who responded to the survey, 72 percent thought active surveillance was effective for low-risk prostate cancer, and about 70 percent were comfortable routinely recommending this approach.

In spite of these findings, active surveillance or watchful waiting still lags behind aggressive treatment, which would include surgery and radiation therapy. Part of the explanation for the higher rates of surgery and radiation therapy rather than active surveillance in the treatment recommendation for low-risk prostate cancer may also reflect patient preferences. Many patients are very uncomfortable “living with their cancer.”

Despite the push for the more aggressive treatments that physicians continue to promote, this current study suggests a positive trend toward active surveillance. Surgeons and radiation oncologists agree that this approach is entirely safe and does not decrease the survival rate from early-stage prostate cancer.


Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

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