How tumor stage affects American urologists' surveillance strategies afterprostate cancer surgery

The factors which influence decision-making among urologists are not well u nderstood. We evaluated how tumor stage in patients subjected to potentiall y curative surgery for carcinoma of the prostate affects the self-reported follow-up strategies employed by practicing United States urologists. Stand ardized patient profiles and a detailed questionnaire based on these profil es were mailed to 4,467 randomly selected members of the American Urologica l Association (AUA), comprising 3,205 US and 1,262 non-US urologists. The e ffect of TNM stage on the surveillance strategies chosen by respondents was analyzed by repeated-measures ANOVA. There were 1,050 respondents who prov ided evaluable data of whom 760 were from the US. The three most commonly u sed surveillance modalities by urologists were office visit, serum PSR leve l, and urinalysis. Nine of the 11 most commonly requested modalities were o rdered significantly (p<0.001) more frequently with increasing TNM stage. T his effect persisted through 10 years of follow-up, but the differences acr oss stage were tiny. Fifty-five percent of US respondents do not modify the ir strategies at all according to the patient's TNM stage. Most American AU A members performing surveillance after potentially curative radical prosta tectomy fur otherwise healthy patients use the same follow-up strategies ir respective of TNM stage. These data permit the rational design of a randomi zed clinical trial of two alternate follow-up plans. The two trial arms wou ld employ office visits, blood tests, and urinalyses at different frequenci es based on current actual practice patterns; there would be no imaging tes ts in either arm.