Prostate Cancer Treatment Choices Vary Based on Type
of Specialist Men Choose to See
About half of all men seen just by a urologist; last
week the attention was on the type of prostate cancer screening men
should pursue
March 9, 2010 – For many older men aware of the
risk of prostate cancer as they age, the big decision about prostate
cancer has always been, “What do I do if they find it?” Their focus
shifted earlier this month with the American Cancer Society’s
recommendations on screening, which highlighted the danger and
emphasized talking to your doctor about this testing. Now, the attention
shifts back to treatment with new research showing you get the treatment
most preferred by the doctor you see.
Most senior citizens have always considered the
treatment option the biggest decision
March 9, 2010 – Early this month the American Cancer
Society updated its prostate cancer screening guidelines and emphasized
that men should discuss the “uncertainties, risks and potential benefits
of screening” for prostate cancer even before they decide whether to be
tested.
Men who visit a radiation oncologist appear more
likely to receive radiation therapy for prostate cancer, whereas men who
consult with a urologist with or without a medical oncologist are
treated more frequently with hormone therapy, watchful waiting or a
radical prostatectomy, according to the report in the March 8 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals.
For most of the nearly 200,000 American men
diagnosed with prostate cancer each year, the disease is localized
(i.e., has not yet spread), according to background information in the
article.
Treatment options for these men include
● surgery to remove the prostate and surrounding tissue (radical
prostatectomy),
● radiation treatment,
● hormone therapy (including primary androgen deprivation therapy) or
● watchful waiting (expectant management).
"Selecting the appropriate treatment can be
challenging, since no therapy has emerged as clearly superior," the
authors write. "Patients rely on the clinical judgment, treatment
philosophy and recommendations of counseling physicians to help them
make informed decisions."
Researchers studied almost 6,000 senior citizens,
suggest patients be informed about the differences and similarities in
expected outcomes, make treatment decisions with an experienced surgeon
Clinicians' perceptions regarding optimal prostate
cancer therapy appear to vary by specialty and geographic region. To
assess whether these preferences were associated with treatment
decisions, Thomas L. Jang, M.D., M.P.H., then of Memorial-Sloan
Kettering Cancer Center, New York, and now of The Cancer Institute of
New Jersey, New Brunswick, and colleagues identified 85,088 Medicare
beneficiaries age 65 or older who were diagnosed with prostate cancer
between 1994 and 2002.
Overall,
● 42,309 men (50 percent) were seen only by urologists,
● 37,540 (44 percent) by urologists and radiation oncologists,
● 2,329 (3 percent) by urologists and medical oncologists and
● 2,910 (3 percent) by all three specialists.
Within nine months of diagnosis,
● 21 percent (18,201) had a radical prostatectomy,
● 42 percent (35,925) received radiation therapy,
● 17 percent (14,021) underwent primary androgen deprivation therapy
and
● 20 percent (16,941) chose watchful waiting.
The type of treatment was strongly associated with
the type of specialist consulted.
Thirty-four percent of men who were seen
exclusively by a urologist had a radical prostatectomy; it was the most
frequent form of therapy in men 65 to 74 years who were seen only by
urologists.
In contrast, radiation therapy was the most common
treatment for men of all ages who saw both radiation oncologists and
urologists.
Those seen by 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.
Visits to primary care physicians were infrequent
between the time a man was diagnosed and when he started treatment;
● 22 percent of patients visited any primary care clinician during
this timeframe, and
● 17 percent visited a primary care clinician with whom he had an
established relationship.
Regardless of age, co-occurring illnesses or
specialist visits, men who saw primary care clinicians were more likely
to be treated with watchful waiting.
"Our findings provide new insight into the
relationship between physician visit patterns and receipt of therapy for
localized prostate cancer," the authors write.
"Prior physician surveys suggest that urologists
and radiation oncologists might recommend their own treatment modality
based on their stated preferences in response to hypothetical survey
questions. The pattern of specialist visits and treatment that we
observed suggests that these preferences 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,"
they conclude.
Editor's Note: This study was funded by a National
Institutes of Health Ruth Kirchstein National Research Service Award and
grants from the National Cancer Institute.
MIRP, especially with robotic assistance, increased from 1% to 40% of radical prostatectomies from 2001 to
2006,despite limited data on outcomes and costs
Sarcosine is better indicator of advancing disease
than traditional prostate specific antigen test (PSA); it is detected in
urine, researchers hopeful simple urine test can be used
March 9, 2010 – For many older men aware of the
risk of prostate cancer as they age, the big decision about prostate
cancer has always been, “What do I do if they find it?” Their focus
shifted earlier this month with the American Cancer Society’s
recommendations on screening, which highlighted the danger and
emphasized talking to your doctor about this testing. Now, the attention
shifts back to treatment with new research showing you get the treatment
most preferred by the doctor you see.
