Purpose: To identify physician characteristics and beliefs associated with active surveillance (AS) recommendation by urologists and radiation oncologists for men with low-risk prostate cancer (LRPC).
Methods: Cross-sectional survey of prostate cancer specialists in Michigan and Georgia, U.S.
Results: Overall, 225 practicing urologists and 95 radiation oncologists participated, with a 36% response rate. While both urologists and radiation oncologists reported that AS is effective, that they discussed AS with all eligible LRPC patients, and provided AS themselves, responses were higher among urologists compared with radiation oncologists (96% vs. 89%, P = 0.02; 97% vs. 90%, P = 0.01; 99% vs. 95%, P = 0.026, respectively). A higher proportion of urologists compared with radiation oncologists endorsed that Black men were more likely to have aggressive LRPC (79% vs. 63%, P = 0.004) and perceived a survival benefit for definitive therapies among men with LRPC. While urologists were more likely to recommend AS than radiation oncologists, especially when patients reported a lower fear of cancer progression (OR = 2.27, P = 0.003), both specialists were less likely to recommend AS to younger men (OR = 0.53, P < 0.001) and Black men (OR = 0.88, P < 0.001). Physicians in Georgia were less likely to recommend AS compared with physicians in Detroit (OR = 0.64, P = 0.024). AS recommendation likelihood decreased with years in practice (OR = 0.97 per year, P = 0.001).
Conclusions: AS recommendations varied by physician specialty, practice location, years in practice, and patients' characteristics. These findings highlight clinician-related factors as underrecognized but actionable contributors to variability in AS uptake. Addressing clinician-level barriers may improve consistency in AS recommendations and support more equitable, guideline-concordant care.
Keywords: Active surveillance; Low-risk prostate cancer; Radiation oncologists; Treatment recommendation; Urologists.
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