With the ongoing 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 2014 study published in the journal Medical Care showed that 45 percent of urologists recommended surgery, 35 percent recommended radiation therapy, and only 22 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 8 times more likely to recommend radiation therapy than surgery, and urologists were 4 times more likely to recommend surgery than radiation.

The study, led by Dr. Simon Kim of the Department of Urology at Yale University School of Medicine, assessed the attitudes and treatment recommendations for low-risk prostate cancer from a national survey of prostate cancer specialists. A total of 1,366 physicians in the United States who are active in the treatment of prostate cancer 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 717 physicians who responded to the survey, 72 percent thought active surveillance was effective for low-risk prostate cancer, and 69 percent were comfortable routinely recommending this approach.

Despite these findings, active surveillance or watchful waiting still lags behind aggressive treatment, which includes 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.


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