PCPs and urologists offer hope with active surveillance

This study considers the perspectives of primary care physicians (PCPs) and urologists on what facilitates and what creates barriers to active surveillance (AS) care for men with low-risk prostate cancer. Researchers conducted in-depth, semi-structured interviews with 19 PCPs (9 female, 4 in community practices, 15 in academic medical centers) and 15 urologists (3 female, 5 in private practice, 3 in academic medical centers) between June 2020 and March 2021. Their goal was to assess interviewees’ knowledge of AS, what factors they felt influence adherence to follow-up testing, and their preferences concerning PCPs’ and urologists’ roles in team-based care delivery.

Both PCPs and urologists noted the importance of patient education. Patients who understand AS are more likely to select it and adhere to follow-up. While urologists were most knowledgeable about AS, PCPs may lack a good general understanding of AS as well as its follow-up protocols and how to interpret test results. They may find it difficult to explain AS to their patients and often defer to urologists.

Both PCPs and urologists recognized that patients can become lost to follow-up. One way to prevent this is for doctors to communicate more directly with each other about a shared patient’s treatment (e.g., by phone instead of electronic health records). PCPs should discuss urologist visits with their patients. However, PCPs and urologists tended to agree that the PCP role in AS is mainly supportive, with urologists handling follow-up care.

What we know: Over the past 20 years, U.S. national guidelines for managing care for men with low-risk prostate cancer have moved away from surgery or radiation, with their risk of overtreatment and harmful side effects, in favor of active surveillance (AS). AS involves routine urologist visits, prostate-specific antigen (PSA) lab testing, and serial tumor burden reassessment with magnetic resonance imaging (MRI) or prostate biopsy at recommended intervals. As of 2021, AS has increased to nearly 60% nationwide, though adherence to treatment and follow-up have been uneven, and some men whose condition is stable may receive more intensive treatment than they need. At the same time, patients are increasingly involving their PCPs in their cancer care.

What this study adds: While prior studies have addressed the role of PCPs in team-based care delivery for cancer survivors, PCPs’ role in AS care for men with low-risk prostate cancer remains unexplored. The PCPs and urologists interviewed for this study revealed how they view their complementary roles in AS care. Clear communication-;between doctors and patients as well as among care team members-;is essential. Urologists have greater knowledge of AS and take the lead in managing treatment for patients with low-risk prostate cancer.