Table 3.

Variability in physician quotes about the utility and quality of various testing options during active surveillance, ranging from favorable on the left to unfavorable on the right.

PSA	“I still think PSA is the sort of gold standard that many of us still follow.”	“I mean I usually get PSA, you know, every 6 months or so and I have a couple patients where that has sort of been a trigger for treatment when other things looked okay. More often biopsy changes or patient preference has been a trigger for treatment but I don’t totally dismiss the PSA.”	“The advantages are if it’s stable, it gives the patients some assurance that what they’re doing is correct. The downside is that PSA is not particularly accurate in checking the extent of the disease or grade of disease.”	“So I would say that [PSA tests] that’s mostly to satisfy the patients. I think the value of doing those things is pretty limited.”
Marker tests	“Mainly I tend to use Oncotype DX, you know, Genomic Health. I haven’t really done a lot of Prolaris but I am excited about that. They’re hopefully going to be coming out soon for surveillance.”	“Although all the genomic tests are first generation tools I think all the decision analytics have shown that they make us make better decisions than if we don’t use them and therefore we should use them. I like genomics because they’re objective and so you can have instead of relying on a local pathologist who may or may not be an expert in prostate cancer.”	“But you know these genomic tests I’m sure they have value. I actually think they do but they’ve been rolled out so quickly and so broadly that we’re not really able to figure out what that value is.”	“I don’t think they’re that useful and I’ve had a couple of patients who have had them. You know, who have requested them because they just were aware of them and we got it and I didn’t feel like it was helpful.”
MRI	“There is not a single patient that I will put on active surveillance unless they’ve had an MRI.”	“Imaging, we use -- obviously, they can’t have evidence of metastatic disease, but we know have started to incorporate MRI’s into our algorithms for following these patients so MRI’s would make a difference.”	“I think in some cases, the MRI could replace the second confirmatory biopsy and select people earlier who might have ended up failing a year or two down the road.”	“The problem with MRI is I don’t think we know enough about it yet. If you look at the data MRI misses about 15% of high grade tumors grade 7 or above. And MRI makes it more likely for you to find a high grade tumor but it doesn’t tell you whether that high grade tumor needs to be treated.”
Biopsy	“Probably the biopsy results are the most important. The surveillance biopsy results.”	“I was, kind of having everyone get biopsies every year and really looking at biopsy changes as a major thing. And then in the last couple of years I started to loosen a little bit, you know, how often people get biopsies, particularly when everything is pretty reassuring.”	“Obviously most guys want to stay away from biopsies if they can and if I find that the MRI is negative or it doesn’t show a concerning lesion then I don’t feel bad about, you know, going a little longer before we do a confirmative biopsy, you know, up to about a year even.”	“I like to do as few biopsies as possible…I like to space them out every couple of years, 2, 3, even 4 years.”