© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
June 3, 2007
The type of treatment men choose for localized prostate cancer is influenced by the type of doctor they see, according to a new study.
Treatment options for localized prostate cancer include surgery to remove the prostate, radiation therapy, hormone-reduction therapy, and active surveillance (the cancer is closely monitored until treatment is needed). These treatments have different side effects. For example, removal of the prostate may cause urinary incontinence (inability to control urine flow) and impotence (inability to have or maintain an erection). Radiation therapy may cause diarrhea and urinary problems. Hormone therapy may cause breast tenderness, loss of sex drive, and digestive problems. Although no medical side effects are associated with active surveillance, it may cause worry and anxiety.
Using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare linked program, the researchers analyzed the records of 85,088 men with localized prostate cancer who were age 65 or older and diagnosed between 1994 and 2002. They found a strong association between a doctor's specialty and the treatment the patients ultimately received. For example, 70% of men between 65 and 69 had their prostates surgically removed when they saw a urologist, but only 15% had their prostates surgically removed when they saw both a urologist and a radiation oncologist. Similarly, 78% of men 65 to 69 and 85% of men 70 and older chose radiation therapy more often when evaluated by both a urologist and radiation oncologist.
What This Means for Patients
Most patients with prostate cancer are seen by a urologist first because urologists are generally the doctors who perform biopsies and diagnose prostate cancer. However, this study shows that it is important to discuss treatment options with specialists in addition to the urologist, if possible.
"Because no one has definitively shown that one treatment for prostate cancer is better than another, most patients make treatment decisions based on recommendations of their doctors and a personal tolerance for the various side effects," said Thomas L. Jang, MD, MPH, Instructor in the Department of Urology at Memorial Sloan-Kettering Cancer Center in New York City and the study's lead author. "Given that, it's very important for patients to receive an unbiased, balanced perspective on the full range of treatment options."