|
 Urologists who had been practicing for more years and those who
treated more advanced cases of the disease were less likely to use a
wait-and-see approach to manage low-risk prostate cancer,
researchers found.
“The physician a patient sees can influence their treatment fate,”
said Dr. Karen Hoffman. “Physicians play an important role in
whether or not men with low-risk prostate cancer are managed with
observation or treatment.”
Hoffman is the study’s lead author from the University of Texas MD
Anderson Cancer Center in Houston.
Almost 200,000 men are diagnosed with prostate cancer each year in
the U.S. and about 30,000 die from it, according to the Centers for
Disease Control and Prevention.
Hoffman and her colleagues write in JAMA Internal Medicine that
non-aggressive, also known as low-risk, prostate cancer is not
likely to lead to symptoms or affect how long men live.
Instead of treating men with surgery to remove their prostate,
radiation or other methods, medical organizations have endorsed the
use of active surveillance or observation to make sure a low-risk
cancer is not growing or advancing.
That’s in part because treatment for prostate cancer can lead to
complications like rectal bleeding, impotence and problems with
bladder control.
Which treatments patients receive is thought to be dependent on
several factors, including their age and the severity of their other
health conditions.
It hasn’t been known whether doctor characteristics influence
treatment decisions, however.
For the new study, the researchers analyzed data from 12,068 men
ages 66 years and older who were diagnosed with low-risk prostate
cancer by 2,145 urologists between 2006 and 2009.
Only about a fifth of the men were treated with active surveillance.
The rest received up-front treatment, such as surgery or radiation.
The proportion of patients that each doctor put on active
surveillance varied from less than five percent to about 64 percent.
The researchers found that doctor characteristics were twice as
important as patient characteristics, such as age and other
conditions, in predicting whether a patient would receive active
surveillance or up-front treatment.
[to top of second column] |
Doctors who treated more aggressive prostate cancers and those who
had been practicing urology longer were more likely to use treatment
other than active surveillance, the researchers found.
They suggest doctors who treat more advanced cancers may choose more
aggressive treatment even for their low-risk patients because they
have seen the damage prostate cancer can do if left untreated. It
may also be that doctors are incentivized to use more aggressive
treatment because it pays more.
“The rate of treatment of older men with low-risk disease is well
documented to be extremely high,” said Dr. H. Ballentine Carter,
professor of urology and oncology at Johns Hopkins Medicine in
Baltimore.
“I think patients need to be aware,” said Carter, who was not
involved with the new study. “They may never become aware before
they undergo treatment. I think we need to do a better job of
educating older individuals with low-risk disease.”
He said the question should not be which treatment men need but
whether they need to be treated.
A second study published in the same journal found that another
treatment for prostate cancer known as androgen-deprivation therapy
did not improve survival for older men with low-risk disease after
15 years.
One option for reducing potentially unnecessary treatment is for the
observation rates of doctors who treat prostate cancer to be made
public so primary care doctors would know that information before
they referred their patients.
Of course, Hoffman said doctors would also want to base their
decision on other measures, such as complications after treatment
and follow-up care, because active surveillance is not always the
best treatment option.
“There is variation in physician use of active surveillance,” she
said. “I think patients should ask their urologists and radiation
oncologists if they are candidates for active surveillance.”
SOURCE: http://bit.ly/1kpBvnP and http://bit.ly/1mbqExp JAMA
Internal Medicine, online July 14, 2014.
[© 2014 Thomson Reuters. All rights
reserved.] Copyright 2014 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed. |
