By: Dudley Seth Danoff, MD, FACS

With the current controversy on prostate cancer screening and PSA (prostate specific antigen) testing, a trend appears to be developing away from aggressive surgical treatment for early stage localized prostate cancer. Whether this approach fits within the standard of care in a particular case must be determined by a prostate cancer expert witness.

Today most urologists and radiation oncologists regard watchful waiting or active surveillance as an effective strategy for managing low-risk prostate cancer.  However, whether physicians recommend active surveillance to their patient varies dramatically depending on patient age, tumor size, and prostate specific antigen (PSA) levels. A prostate cancer expert witness evaluating a case should take all of these factors into consideration as well.

A study published in the Journal of Clinical Oncology dated February 20, 2019, showed that almost 90% of radiation oncologists and 83% of urologists recommended watchful waiting for men in their 70s with small tumors, but only about 4% of radiation oncologists and 5% of urologists recommended active surveillance for men in their 50s with larger tumors.

Researchers Albert Kim, Robert Abouassaly, and Simon Kim assess the attitudes of treatment recommendations for low-risk prostate cancer from a national survey of prostate cancer specialists.  Between January and July 2018, 940 physicians in the United States, who are active in the treatment of prostate cancer, were surveyed.  All of the physicians were asked how they view active surveillance as well as what their treatment recommendations were for patients diagnosed with low-risk prostate cancer.  Of the 691 physicians who responded to the survey, 92% of the urologists and 87% of radiation oncologists thought active surveillance was affected for low-risk prostate cancer.

In spite of these findings, active surveillance or watchful waiting still lags behind aggressive treatment, which would include robotic surgery and radiation therapy.  Part of the explanation for the higher rates of surgery and radiation rather than the active surveillance in the treatment recommendations for younger low-risk prostate cancer patients may also reflect patient preferences.  Nearly half of the radiation oncologists surveyed reported that active surveillance “increases patient anxiety”.

Despite the reluctance of some physicians and patients to trust a newer, less aggressive strategy, this current study suggests a positive trend toward active surveillance.  Surgeons and radiation oncologists agree that this approach is entirely safe and does not decrease the survival rate from early-stage prostate cancer.

The issues remain nuanced and require the prostate cancer expert witness to have broad and extensive experience in all aspects of the diagnosis, treatment, and care of patients with prostate cancer when determining the appropriate standard of care in a specific case.

Dr. Danoff is an award-winning urologist. He is in active clinical practice at Cedars-Sinai Medical Center in Los Angeles, CA. He is also on the faculty at UCLA. Dr. Danoff graduated from Princeton, summa cum laude, and Yale (honors) and completed his Urology Residency and Surgical Internship at Columbia-Presbyterian Medical Center. He has significant research experience as a principal investigator and sub-investigator and has spoken at conferences both nationally and internationally. Dr. Danoff is also the author of several books and numerous peer-reviewed articles. He was the former Urology Surgeon-in-Chief to the King of Thailand. Dr. Danoff is a highly experienced expert witness and has reviewed hundreds of legal cases and testified in dozens of depositions and trials. He can be contacted at (310) 625-1377 or