AIM: Prostate cancer treatment may differ depending on consulting specialist

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According to a recent study published in the March 8 issue of Archives of Internal Medicine, prostate cancer patients who visit a urologist with or without a medical oncologist consultation are treated more frequently with hormone therapy, watchful waiting or a radical prostatectomy, while those who visit a radiation oncologist appear more likely to receive radiation therapy for the treatment of their disease. 

Thomas L. Jang, MD, of the Cancer Institute of New Jersey in New Brunswick, and colleagues found that in addition to treatment methods varying depending on which specialist was consulted, they also varied by geographic location.  “Selecting the appropriate treatment can be challenging, since no therapy has emerged as clearly superior,” the authors noted.

The researchers recruited 85,088 Medicare beneficiaries age 65 or older who were diagnosed with prostate cancer between 1994 and 2002.  The patients were recruited by way of the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database which links patient demographic and tumor-specific data. Of these men, 50 percent were seen only by urologists, 44 percent by urologists and radiation oncologists, 2,329 (3 percent) by urologists and medical oncologists and 3 percent by all three specialists.

After a follow-up period of nine months post-diagnosis, the authors found that the men who had consulted with urologists with or without medical oncologists, were more likely than those evaluated by urologists and radiation oncologists to receive primary androgen deprivation therapy or watchful waiting.  Those patients treated by both radiation oncologists and urologists most commonly received radiation therapy.  In addition, 34 percent of men who were seen exclusively by a urologist underwent a radical prostatectomy and men who saw their  primary care clinicians between the time of diagnosis and treatment were found to have a greater likelihood of being treated with watchful waiting.

Jang and colleagues wrote that overall, 21 percent of patients underwent a radical prostatectomy, 42 percent received radiation therapy, 17 percent underwent primary androgen deprivation therapy and 20 percent selected watchful waiting as a treatment method.

“Patients rely on the clinical judgment, treatment philosophy and recommendations of counseling physicians to help them make informed decisions,” said the authors. “Our findings provide new insight into the relationship between physician visit patterns and receipt of therapy for localized prostate cancer.”

The authors wrote that the results of their study may shed light on whether or not urologists and radiation oncologists typically recommend their own treatment modality and if the preferences of these specialists may be affecting treatment decisions of Medicare patients.

“This finding and the known preferences of prostate cancer specialists for the treatment they themselves deliver underscores the need to ensure that all men are well informed and have access to balanced information prior to making this important treatment decision,” Jang concluded.