New research from The University of Texas MD Anderson Cancer Center is shedding light on the important role a diagnosing urologist plays in whether older men with low-risk prostate cancer receive treatment for their disease, and if so, the type of treatment they receive as a result.
The findings, published in JAMA Internal Medicine, sought to examine why active surveillance, a management program for low-risk disease, which includes repeat PSAs, prostate exams and biopsies, is underused in this patient population.
According to the American Cancer Society, 233,000 new cases of prostate cancer will be diagnosed this year, making it the most common non-skin cancer in men. Previous studies have shown mortality rates are similar for those who opt for surveillance versus treatment in this older population, yet many men continue to incur unnecessary treatment harms.
"What's striking was just how much variation exists in managing prostate cancer, with the diagnosing physician playing as much a role, if not more of a role, than accepted patient factors that impact surveillance use," said Karen Hoffman, M.D., assistant professor in Radiation Oncology and lead author.
Using the Surveillance, Epidemiology and End Results (SEER) registry, researchers identified 12,068 men ages 66 and older diagnosed with low-risk prostate cancer from 20062009. Physician characteristics were obtained from linked Medicare claims to determine variations attributable to medical degree, year of training, training location and board certifications.
The main outcome was no cancer-directed therapy within 12 months of diagnosis. Researchers also set to determine the impact of the diagnosing urologist on treatment decisions, quantify the rate of surveillance versus treatment and identify urologist and patient factors associated with surveillance selection.
Results Indicate Widespread Differences
Of the 12,068 men, 80 p
|Contact: William Fitzgerald|
University of Texas M. D. Anderson Cancer Center