New research published in today's issue of the Archives of Internal Medicine (Vol. 170, No. 5), by an investigator at The Cancer Institute of New Jersey (CINJ) and colleagues at Memorial Sloan-Kettering Cancer Center in New York, shows that the type of specialist that men with localized prostate cancer see can influence the form of therapy they ultimately receive. The study found that patients aged 65 to 69 years old who consult a urologist are more likely to undergo surgery to remove the prostate, while those who consult a radiation oncologist and a urologist, regardless of age, usually receive radiation therapy. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.
Previous research published in JAMA in 2000 (F.J. Fowler, Jr., et. al.) found that when U.S. urologists and radiation oncologists were surveyed on how they would treat patients with localized prostate cancer, specialists overwhelmingly would recommend the treatment modality that they themselves delivered. However, no evidence to date has determined whether the type of specialist men see after a prostate cancer diagnosis influence the eventual treatment chosen.
This latest study examined 85,088 men aged 65 and older who were diagnosed with localized prostate cancer between 1994 and 2002 using information from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database to determine the type of specialist they saw and the therapy they received. The treatments included radical prostatectomy (surgery to remove the prostate), radiation therapy, primary androgen deprivation (hormone) therapy, and expectant management (an approach also known as watchful waiting, which involves no treatment and frequent monitoring of the patient).
Among the men in the study, 50 percent were seen exclusively by a urologist; 44 percent by both a radiation oncologist and a urologist; three percent by both a medical oncologist and a urologist; and three percent by all three specialists. A high correlation was observed between the type of specialist patients saw and the treatment they received. This was especially true in the younger men aged 65 to 69, where 70 percent of men who saw only a urologist had a radical prostatectomy. However, if men in this group saw a radiation oncologist and a urologist, 78 percent had radiation therapy. If men aged 65 to 69 years old saw a medical oncologist and a urologist, 53 percent had a prostatectomy and nearly equivalent numbers had either radiation therapy (17 percent), expectant management (16 percent), or primary androgen deprivation therapy (14 percent).