ASCO: Consider Source of Localized Prostate Cancer Recommendations

CHICAGO, June 4 -- Localized prostate cancer needs a balanced view of treatment options from both urologists and radiologists, researchers said here.

Most younger Medicare-age patients who saw only a urologist before deciding on treatment opted for radical prostatectomy, said urologist Thomas L. Jang, M.D., of Memorial Sloan-Kettering Cancer Center in New York, and radiation oncology colleagues, at the American Society of Clinical Oncology meeting.

Older men overwhelmingly chose primary androgen therapy or watchful waiting, the investigators found in a review of data on 85,000 men in the National Cancer Institute's Medicare-linked Surveillance, Epidemiology and End Results (SEER) database.

In contrast, patients of all ages favored radiation therapy if they had pretreatment visits with a urologist and a radiation oncologist.

Although many men have a radical prostatectomy without seeing a radiation oncologist, "urologists exercise discretion," said Dr. Jang. "They rarely perform radical prostatectomy on men who have a limited life expectancy based on advanced age."

Noting that most patients opt for radiation therapy if they have a radiation oncology consult, he emphasized that "it is essential that men have access to balanced information."

None of the principal treatment options for prostate cancer has clearly demonstrated superiority over the others, Dr. Jang noted. As a result, most patients decide on treatment on the basis of physician recommendations and perceived tolerance for different types of adverse effects. Within that decision-making environment, prostate cancer patients should get an unbiased, balanced perspective on treatment options.

The SEER data included men who had been diagnosed from 1994 through 2002, and all were 65 years or older when diagnosed.

Half the men consulted only a urologist before making a treatment decision. Another 44% saw a urologist and a radiation oncologist, 3% consulted a urologist and medical oncologist, and 3% received input from all three specialties.

Treatment choices varied by patient age. Most men ages 65 to 69 opted for prostatectomy (44%) or radiation therapy (39%). The preference shifted toward radiation oncology (52%) for men ages 70 to 74, and only 6% that age had prostatectomies. Most ages 80 and older opted for primary androgen deprivation therapy or watchful waiting, and only 1% had surgery.

Of 42,309 men who consulted only a urologist, 34% had a prostatectomy, 27% chose androgen deprivation, and 34% opted for watchful waiting, leaving only 6% who chose radiation therapy. Choices varied distinctly by age. Dr. Jang reported than 70% of men ages 65 to 69 had radical prostatectomy if the consulted only a urologist.

The proportion opting for surgery decreased to 45% of those ages 70 to 74, 10% of those 75 to 79, and 1% of those 80 and older. The number opting for androgen deprivation or watchful waiting increased with age. No more than 8% of any age group chose radiation therapy.

The picture changed dramatically when patients consulted both a urologist and a radiation therapist. Of the 37,540 who saw physicians in both specialties, 83% chose radiation. Among all age groups, the proportion of patients choosing radiation therapy ranged from 79% to 87%. Prostatectomy was favored by 15% of men ages 65 to 69 years but by no more than 7% of men in the older age groups.

Echoing Dr. Jang's conclusions, Bend, Ore., oncologist Archie Bleyer, M.D., who moderated the presentation, said "the results are of concern and affect more men than not."