Introduction: Many men with low-risk prostate cancer continue to receive radical treatment despite the safety of active surveillance (AS). Recent data suggests that global rates of AS in eligible patients range from 39-67%. Patient-related barriers to AS have been reported extensively. However, there is limited data exploring clinician-related barriers to AS. This study aims to identify these barriers.

Methods: Urologists and radiation oncologists in Australia and New Zealand were purposively sampled for a cross-section on gender and practice setting (metropolitan/regional; public/private). Using a grounded theory-methodology, semi-structed interviews were conducted with participants and typed verbatim. Transcripts were coded independently by two researchers using open, axial and selective coding using NVivo software. A constant comparative approach was used to analyse data as it was collected. Thematic saturation was reached after 18 interviews, and a detailed model of clinician-associated barriers to AS for prostate cancer was developed.

Results: Nine urologists and nine radiation oncologists accepted that AS is an evidence-based management strategy for low-risk prostate cancer, with some key themes emerged when considering physician-related barriers to AS. These included access to multidisciplinary team meetings, financial drivers, reduced patient acceptance, and fear of future litigation (see Figure 1 for examples of quotes). In particular, radiation oncologists advocated that patients receive a formal opinion regarding radiation therapy to improve patient awareness and education. Interestingly, most clinicians over-estimated the rates of AS in their region when compared to the published rates.

Conclusions: We identified physician-related barriers to AS for prostate cancer. Some of these barriers may inform future interventions, including implementation of physician decision aids and improved patient support programs, to improve rates of AS in our region and globally.