MedWire News: The prostate cancer treatment a man chooses depends greatly on the type of specialists he consults, researchers report.

Thomas Jang (Memorial Sloan-Kettering Cancer Center, New York, USA) and colleagues analyzed data on 85,088 men from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.

The men were diagnosed with clinically localized prostate cancer at age 65 years or older, between 1994 and 2002, and data were collected on the treatment received within 9 months of diagnosis.

Overall, 50% of the men were seen only by urologists, 44% by urologists and radiation oncologists, 3% by urologists and medical oncologists, and 3% by all three types of specialist.

Jang et al report that 34% of men diagnosed with localized prostate cancer who were evaluated solely by urologists underwent radical prostectomy (RP), 5% chose radiotherapy, 27% hormone therapy, and 34% expectant management.

In contrast, just 8% of men who saw both urologists and radiation oncologists chose RP, with 83% opting for radiotherapy, and 5% each for the other treatment options.

Of note, 80% of men aged 65–74 years who underwent RP had consulted only a urologist, while 93% of men who saw a urologist and a radiation oncologist chose radiotherapy.

Men seen by urologists with or without medical oncologists, particularly those aged 75 years or older, were more likely than those evaluated by both urologists and radiation oncologists to receive androgen deprivation therapy or expectant management.

The researchers note that radiation oncologists saw an increasingly smaller proportion of patients as men aged.

Jang et al also report in the Archives of Internal Medicine that visits to primary care physicians (PCPs) were infrequent between diagnosis and receipt of therapy, with just 22% of patients visiting any PCP and 17% visiting a PCP they had already visited in the previous 12 months. Irrespective of age, comorbidity,or specialist visits, men seen by PCPs were more likely to be treated expectantly.

The researchers comment: “Our study demonstrates a strong association between the types of physicians men visit after a prostate cancer diagnosis and the eventual treatment strategy chosen.

“This finding and the known preferences of prostate cancer specialists for the treatment they themselves deliver underscores the need to ensure that all men are well informed and have access to balanced information prior to making this important treatment decision.”

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