Annals of Surgical Oncology

, Volume 26, Issue 2, pp 660–668 | Cite as

Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists

  • Simon P. KimEmail author
  • Cary P. Gross
  • Nilay D. Shah
  • Jon. C. Tilburt
  • Badrinath Konety
  • Stephen B. Williams
  • Christopher J. Weight
  • James B. Yu
  • Aryavarta M. S. Kumar
  • Neal J. Meropol
Urologic Oncology



The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa.


In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS.


We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent’s specialty.


Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.



This study was supported by a career development award for Dr. Simon Kim from the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO).


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Simon P. Kim
    • 1
    • 2
    • 3
    Email author
  • Cary P. Gross
    • 3
    • 4
  • Nilay D. Shah
    • 5
    • 6
  • Jon. C. Tilburt
    • 7
    • 8
  • Badrinath Konety
    • 9
  • Stephen B. Williams
    • 10
  • Christopher J. Weight
    • 9
  • James B. Yu
    • 3
    • 11
  • Aryavarta M. S. Kumar
    • 12
  • Neal J. Meropol
    • 2
    • 13
  1. 1.Center for Quality and Outcomes, Urology Institute, Case Western Reserve University School of MedicineUniversity Hospitals Cleveland Medical CenterClevelandUSA
  2. 2.Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandUSA
  3. 3.Cancer Outcomes and Public Policy Effectiveness Research (COPPER) CenterYale UniversityNew HavenUSA
  4. 4.Department of MedicineYale UniversityNew HavenUSA
  5. 5.Division of Health Policy and ResearchMayo ClinicRochesterUSA
  6. 6.Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  7. 7.Division of General Internal MedicineMayo ClinicRochesterUSA
  8. 8.Biomedical Ethics Research ProgramMayo ClinicRochesterUSA
  9. 9.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  10. 10.Division of UrologyUniversity of Texas Medical BranchGalvestonUSA
  11. 11.Department of Radiation OncologyYale UniversityNew HavenUSA
  12. 12.Department of Radiation OncologyLouis Stokes Cleveland VA Medical CenterClevelandUSA
  13. 13.Flatiron HealthNew YorkUSA

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