Researchers from several U.S. medical centers have reported that “specialist visits relate strongly to prostate cancer treatment choices.” The details of this study were published in the March 8, 2010 issue of the Archives of Internal Medicine.[1]

Localized prostate cancer can be treated with equivalent results with surgery, external beam radiation therapy, brachytherapy, or combinations of these modalities. There have been no randomized trials comparing the relative efficacy of these treatments, and no such studies are planned. Patients with localized prostate cancer must choose one of the three options based on observational comparisons of outcomes, which makes the choice difficult. In addition, all forms of therapy are evolving. Robotic surgery is replacing conventional surgery; intensity modulated radiation therapy (IMRT) is replacing conventional external beam radiation therapy; and there are methods to improve delivery of radiation such as the Calypso® system. There are also several different methods of delivering brachytherapy; these are often combined with external beam radiation therapy. In addition, cryotherapy and radiofrequency ablation have been added to the list of effective treatments for localized prostate cancer.

Researchers involved in the current study evaluated how visits to specialists and primary care physicians affected treatment choices for men with localized prostate cancer. They used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data base to identify 85,088 men with localized prostate cancer who were 65 years of age or older. These men were treated between 1994 and 2005. The following treatment modalities were identified: 

• Radical prostatectomy = 21%
• Radiotherapy = 42%
• Androgen deprivation = 17%
• Expectant management = 20%
• 50% were seen exclusively by urologists
• 44% were seen by urologists and radiation oncologists
• 3% were seen by urologists and medical oncologists
• 3% were seen by urologists, radiation oncologists, and medical oncologists

The researchers made these observations:

• “There was a strong association between the type of specialist seen and primary therapy received.”
• Men seen by primary care physicians were more likely to be treated expectantly.

Comments: This study confirms what has been obvious for a long time: Specialists usually recommend the therapy they deliver themselves. It is therefore important for men with localized prostate cancer to be better informed about all available therapy from more than one source before selecting a specific therapy.

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