To assess physicians' attitudes regarding multiple factors that may influence recommendations for AS vs. AT given the central role physicians play in the treatment-decision making process.

We conducted semi-structured interviews to assess factors that physicians consider important when recommending AS vs. AT, as well as physicians' perceptions of what their patients consider important in the decision. Participants included urologists (N=11), radiation oncologists (N=12), and primary care physicians (N=10), from both integrated and fee-for-service healthcare settings.

Across the specialties, quantitative data indicated that most physicians reported that their recommendations for AS were influenced by patients': older age, willingness and ability to follow a surveillance protocol, anxiety, comorbidities, life expectancy, and treatment preferences. Qualitative findings highlighted physicians' concerns about malpractice lawsuits, given the possibility of disease progression. Additionally, most physicians noted the role of the healthcare setting, suggesting that financial incentives may be associated with AT recommendations in fee-for-service settings. Finally, most physicians reported spouse/family opposition to AS due to their own anxiety or lack of understanding of AS.

We found that patient and physician preferences, healthcare setting and family/spouse factors influence physicians' treatment recommendations for men with low-risk PCa. These were consistent themes across physician sub-specialties in both an HMO and in fee-for-service settings.