Therapeutic Patterns and Barriers to the Treatment of Advanced Prostate Cancer: A Survey of Academic and Community Urologists in the United States

Introduction In this study we assess urologists' decisions about the treatment of patients with metastatic castration resistant prostate cancer, the perceived therapeutic barriers and urologists' educational gaps. Methods A clinical case based online survey was distributed to a random sample of practicing urologists in the United States. Questions addressed treatment options and physician confidence in treating cases, and included open-ended questions regarding key educational gaps, attitudes and barriers to patient treatment. Results Respondents included 96 community urologists and 29 academic urologists. Academic urologists were significantly more likely to withhold therapy and continue observation than community urologists when treating patients with increasing prostate specific antigen after prostatectomy and radiotherapy (41% vs 24%, respectively, p=0.039). The majority of community and academic urologists referred patients with asymptomatic metastatic castration resistant prostate cancer before chemotherapy to an oncologist (64% and 55%, respectively, p=0.500) as well as those who were symptomatic (62%, p=0.678). More community urologists than academic urologists rated patient comorbidities as a barrier to treatment (mean ± SD 3.74 ± 0.92 and 3.14 ± 0.83, respectively, p=0.003). Appropriate therapy sequencing was highly rated by community and academic urologists as a subject for continuing medical education (67% and 66%, respectively, p=0.91). Conclusions Similarities and differences were observed between community and academic urologists regarding the treatment of patients with metastatic castration resistant prostate cancer and barriers to treatment. Understanding these comparisons may assist in developing educational activities to improve urologist knowledge and, ultimately, patient care in metastatic castration resistant prostate cancer.