Variation in the Appropriateness of Active Surveillance Based on Clinical Versus Proability-Based Risk Assessments

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Judging the appropriateness of active surveillance (AS) for prostate cancer (PCa) involves consideration of multiple factors including patient age, health, and oncological risk. This information is often informally synthesized based on clinical gestalt rather than a standardized approach to judge appropriateness for AS. We evaluated whether urologists perceive differences in the appropriateness of AS based on how PCa risk data is presented. METHODS: Urologists from the Society of Urologic Oncology (SUO) and Michigan Urological Surgery Improvement Collaborative (MUSIC) were surveyed using five patient vignettes in two formats: clinical (PSA and biopsy results) and probability-based (PCa vs. nonPCa mortality). Participants, unaware both formats described the same patient, rated AS appropriateness on a scale from 1 (highly inappropriate) to 9 (highly appropriate). A Wilcoxon matched-pairs signed-ranks test assessed differences between vignette formats. Median appropriateness scores were calculated for each vignette and stratified by fellowship training status in subgroup analysis. Statistical analysis was performed using Stata v15.1, with alpha set at 0.05 and beta at 0.2. RESULTS: Of 57 respondents, 29 were non-fellowship-trained and 28 were fellowship-trained in oncology and/or robotics. Urologists tended to rate patients more appropriate for AS when presented with probability-based vignettes compared with clinical vignettes, especially for patients with high volume grade group (GG) 1 and patients with GG2 disease (Figure 1). Non-fellowship-trained urologists rated vignettes describing patients with 2/12, 4/12, and 5/12 cores ofGG2 disease highly appropriate for AS when given probability estimates (median scores of 7, 8, and 8, respectively) but were more uncertain when given clinical data (median scores of 6, 5, and 5, respectively, p< 0.001 for all three comparisons). Fellowship-trained urologists showed mild differences in appropriateness scores for patients with GG2 based on vignette format. CONCLUSIONS: Urologists were more likely to recommend AS for patients with favorable intermediate-risk PCa when presented with probability-based data estimating PCa vs. non-PCa mortality, and these differences were more pronounced among non-fellowship-trained urologists. These findings support the use of nomograms and probability estimates to guide treatment decisions.

Volume

213

Issue

5S

First Page

e351

Last Page

e352

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vega, NV

DOI

10.1097/01.JU.0001109828.87037.24.17

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