title: The effect of urologist experience on choosing active surveillance for prostate cancer.
abstract: OBJECTIVE
  To evaluate the impact of the urologist's experience in selecting active surveillance (AS) versus immediate treatment (IT) for low-risk prostate cancer.
  
  
  METHODS
  Men with low-risk prostate cancer were enrolled from March 2011 to August 2013 at 13 medical centers in Kaiser Permanente Southern California. The AS cohort was defined as men who had cT1-T2a stage prostate cancer, prostate-specific antigen <10 ng/ml, a biopsy revealing Gleason grade ≤6, fewer than three biopsy cores positive, ≤50 % cancer in any core, and not undergone immediate therapy (surgery, radiation, other) within 6 months following diagnosis. The urologist's experience (age, number of years in practice, number of robotic surgeries performed, and fellowship experience in oncology and/or robotics) was then compared between AS and IT cohorts.
  
  
  RESULTS
  A total of 4754 men were diagnosed with prostate cancer, and 713 men satisfied with inclusion criteria; 433 (60.7 %) and 280 (39.3 %) chose AS and IT, respectively. A total of 87 urologists were included. Univariate and multivariate adjusted analyses revealed no differences in urologist's age or years in practice. Patients who saw urologists who had performed ≥50 robotic surgeries were less likely to choose AS (OR 0.40, 95 % CI 0.25-0.66). Patients who saw urologists with a fellowship in oncology and/or robotics were more than twice as likely to choose AS (OR 2.27, 95 % CI 1.38-3.75).
  
  
  CONCLUSIONS
  These data suggest that the decision to pursue AS may be influenced by the urologist's experience.
authors.affiliation: Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA, 90027, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Chu
authors.affiliation: Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA, 90027, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Slezak
authors.affiliation: Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA.
authors.forename: Teresa N
authors.initials: TN
authors.lastname: Harrison
authors.affiliation: Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA.
authors.forename: Joy
authors.initials: J
authors.lastname: Gelfond
authors.affiliation: Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.affiliation: Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA, 90027, USA. Gary.W.Chien@kp.org.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chien
mesh_terms: D002140:California; D002983:Clinical Competence; D018450:Disease Progression; D004502:Education, Medical, Continuing; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010817:Physician-Patient Relations / Q000941:ethics*; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education / Q000592:standards*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment / Q000379:methods; D066231:Surgeons / Q000592:standards*; D014572:Urology; D057832:Watchful Waiting / Q000379:methods*; D000078329:Workforce
keywords: Education; Oncology; Physician–patient relations; Prostate; Watchful waiting