Minority of Older Patients With Low-Risk Prostate Cancer Managed by Observation Rates Vary Widely Among Urologists and Radiation Oncologists

“Most older men with low-risk prostate cancer receive upfront treatment, despite absence of clear survival benefit and potential for morbidity. In a retrospective cohort study reported in JAMA Internal Medicine, Hoffman et al found that use of observation as management in this setting varied widely among urologists and radiation oncologists. Patients diagnosed by urologists who treat prostate cancer were more likely to receive upfront treatment, which was also likely to be a treatment that the urologist performed.”

Prostate Cancer: Docs Drive Treatment Choice

“Physicians who diagnosed low-risk prostate cancer had more influence over the decision to enter active surveillance than did the disease characteristics, a review of 12,000 cases showed.

“Overall, about 20% of the men chose active surveillance as the initial approach to management. Rates of active surveillance among the diagnosing urologists varied from 4.5% to 64% of patients, according to Karen E. Hoffman, MD, MPH, of MD Anderson Cancer Center in Houston, and colleagues.

“Analysis of factors that influenced treatment decision showed that the diagnosing physician had more than twice the impact on the choice of upfront therapy as compared with disease characteristics, as reported online in JAMA Internal Medicine.”

The gist: Some low-risk prostate cancer patients and their oncologists might choose to delay immediate treatment in favor of active surveillance, in which the tumor is closely monitored for any changes that might necessitate further action. The study described in this article found that the decision to forgo treatment in favor of active surveillance has more to do with the particular doctor being consulted than with the characteristics of the patient’s disease itself. Of particular interest was the finding that patients who only saw a urologist were more likely to go with the active surveillance option than patients who also consulted a radiologist.

Most Prostate Cancer Specialists Don't Recommend Active Surveillance for Low-Risk Patients

“Specialists who treat prostate cancer agree that active surveillance is an effective option—yet most don’t recommend it when appropriate for their own patients, according to a study in the July issue of Medical Care .

“Rather, urologists are more likely to recommend surgery and radiation oncologists are more likely to recommend radiation therapy—the treatments provided by their own specialties. ‘Given the growing concerns about the overtreatment of prostate cancer, our study has important policy implications about possible barriers to promoting active surveillance and specialty biases about optimal treatment regarding localized prostate cancer,’ comments Dr Simon P. Kim of Yale School of Medicine.”