Introduction: With the rapid utilization of new advanced technology for localized prostate cancer (PCa), we performed a national survey of radiation oncologists (RO) and urologists (URO) to assess the perceptions on outcomes for robotic-assisted radical prostatectomy (RARP) and proton radiotherapy (PRT) compared with open radical prostatectomy (ORP) and intensity-modulated radiation therapy (IMRT).
Methods: In 2012, we surveyed 1,366 PCa specialists on whether RARP and PRT provided better cancer control, treatment-related toxicities, and quality of life (QOL) relative to conventional treatments. Pearson’s chi-square test and multivariate logistic regression were used to test for the association between physician characteristics and perceptions of PRT versus IMRT and RARP versus ORP.
Results: Overall, 717 (52%) respondents completed the survey. Few specialists believed that PRT was superior to IMRT for cancer control (2.1%), urinary incontinence (3.9%), or sexual dysfunction (4.5%). RO were more likely than URO to perceive PRT had less treatment-related rectal toxicity (28.5% vs. 15.5; adjusted OR: 2.49, p<0.001), risks for hip fracture (28.5% vs. 4.5% adjusted OR: 9.43, p<0.001), and secondary malignancies (28.5% vs. 11.2%; adjusted OR: 4.65, p<0.001). A third of respondents agreed that RARP conferred less urinary incontinence (32.9%) and sexual dysfunction (30.0%) relative to ORP, but with no differences in cancer control. Respondents with access to robotic surgery in their practice believed RARP superior to ORP in having less urinary incontinence (adjusted OR: 2.71; p<0.001) and sexual dysfunction (adjusted OR: 3.21; p<0.001) compared to those without access.
Conclusions: RO and URO largely view the benefits of PRT and RARP from less treatment-related toxicity and QOL implications for patients with localized PCa. However, neither RO and URO considered either newer treatments conferring better cancer control. Source of
Funding: This study was supported by a Robert Derzon Award, Informed Medical Decisions Foundation and a Career Development Award for Dr. Simon Kim from the Conquer Cancer Foundation and American Society of Clinical Oncology (ASCO).
