Surgery News - October 2007 - (Page 10)

10 UROLOGY SURGERY NEWS • O C T O B E R 2 0 0 7 Specialist Visits Influence Prostate Cancer Treatment BY JANE SALODOF MACNEIL Else vier Global Medical Ne ws C H I C A G O — Whether a man consults with a urologist, a radiation oncologist, or a primary care physician after being diagnosed with clinically localized prostate cancer can lead to different treatment choices. A study of 85,088 men, aged 65 years and older and diagnosed from 1994 to 2002, found that half saw only a urologist. These patients were more likely to have a radical prostatectomy, primary androgen depriva- tion therapy, or expectant management. Only 5% went on to radiation therapy. Fewer than half (44%) of men diagnosed during this time period consulted a radiation oncologist after diagnosis by a urologist. Most men who saw both specialists had radiation therapy. Only 8% underwent radical prostatectomy. Even fewer chose the conservative options of hormone treatment or watchful waiting. Most men did not visit their primary care physicians after diagnosis. The 17% who did tended to be older and usually opted for a conservative strategy. Just 6% of the men also consulted a medical oncologist. “[Whom you see] does sort of influence what you get,” Dr. Thomas L. Jang said after reporting the results of the study at the annual meeting of the American Society of Clinical Oncology. His presentation generated extensive discussion, as audience members questioned whether the men who consulted radiation oncologists had actually been referred for radiation therapy by their urologists. This, in turn, raised the ques- tion of whether urologists were giving men full information on all treatment options before choices were made. Dr. Jang, a urologist at Memorial SloanKettering Cancer Center, New York, emphasized that no treatment has been proved best for early prostate cancer. Results show that treatment choices are strongly associated with which specialists a patient consults, but other factors—such as patient preferences and distance to radiation or surgical facilities—might also play a role. Responding to a question, he said the study also found regional differences, but he did not present those data. Urologists generally make the diagnosis of prostate cancer and coordinate care. Dr. Jang said he did not recommend that urologists send all prostate cancer patients to consult with both radiation oncologists and medical oncologists. The health care costs would be too great, and it would lessen the efficiency of physician practices. Rather, he advocated that urologists and radiation oncologists collaborate on standard informational materials given to patients. “It is essential that all men with prostate cancer have balanced information prior to making a treatment decision,” he said, noting that urologists, radiation oncologists, and medical oncologists collaborated on the study he presented. Dr. Jang and his coinvestigators matched information from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database with Medicare claims and the American Medical Association’s Physician Masterfile. They found that for the 8-year period studied, 42% of localized prostate cancer patients aged 65 and older underwent radiation therapy, 21% had a radical prostatectomy, 17% had primary androgen deprivation therapy, and 20% had expectant management. Patients younger than 75 were more likely to have surgery and/or radiation, whereas most of those aged 80 and older opted for more conservative strategies. For those aged 75-79 years, half had radiation therapy, 24% had expectant management, 20% primary androgen deprivation therapy, and just 6% radical prostatectomy. Dr. Jang credited urologists for exercising discretion in that they rarely operated on or ordered radiation therapy for older men with limited life expectancy. Radical prostatectomies were done in 34% of all 42,309 men who saw only a urologist, but the proportion fell from 70% of those aged 65-69, to 45% of those 70-74, to 10% of those 75-79, and to just 1% of those 80 and older. In contrast, 83% of 37,540 patients who also consulted a radiation oncologist had radiation therapy. Percentages by age group were 78% of those aged 65-69, 85% of those aged 70-74, 87% of those aged 7579, and 79% of those 80 and older. Just 14,599 men also visited a primary care physician. Expectant management was the leading treatment in these patients, followed by androgen deprivation. Even among those who also consulted a urologist and a radiation oncologist, 51% chose watchful waiting, whereas just over a third (34%) opted for radiation therapy. Continued on following page http://www.karlstorz-hd-endoscopy.com http://www.karlstorz-hd-endoscopy.com

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