Prostate Cancer: How Docs Influence Patient Choices

We all know intuitively that when we have a physical ailment, the type of doctor we see can determine the type of treatment we receive. But statistics released at the American Society for Clinical Oncology meeting on June 3 made the point with exceptional clarity. According to a new study, men with early prostate cancer who consult only one doctor—a urologist—overwhelming opt for surgery to remove the prostate. By contrast, those who consult both a urologist and radiation oncologist usually end up having radiation therapy instead. A study two weeks ago at the American Urological Association meeting reached almost exactly the same conclusion. "The takeaway message for patients is that it matters who you see, and it makes a difference whether you have access to balanced information from all the different specialties," says radiation oncologist Justin Bekelman of Memorial Sloan-Kettering Cancer Center in New York, co-lead author of the study released today.

The paper is strong because it relies on an enormous Medicare-linked database. Bekelman and co-lead author Dr. Thomas Jang, a urologist at Sloan-Kettering, were able to examine 1994-2002 data from more than 85,000 men aged 65 and older. They found that 50 percent of patients were seen exclusively by a urologist and 44 percent by both a radiation oncologist and urologist. Overall, there was a high correlation between treatment and the type of specialists patients consulted. But it was especially pronounced in men aged 65 to 69 who had localized cancer, meaning cancer that is still contained within the prostate. Among these patients, 70 percent of those who consulted a urologist alone ended up in surgery. By contrast, those who consulted both specialties ended up choosing radiation 78 percent of the time.

Prostate cancer is the second most common cancer among men after skin cancer, with 235,000 new cases diagnosed last year. For those aged 65-69, there's no evidence that either treatment is superior. In fact, both appear to be successful most of the time. But the procedures—and side effects—differ substantially.

Those who are treated with a radical prostatectomy face an invasive procedure with all the attendant risks of anesthesia and infection. They spend two to three days in the hospital and another four to six weeks recuperating at home. Erectile dysfunction is a possible side effect. And, because surgery can affect the sphincter muscle that controls urination, a certain degree of leakage can be expected after the surgery (although most patients regain control later on). That said, some men prefer this option, because once cancer is diagnosed, says Bekelman, "they just want the prostate out."

With external-beam radiation therapy, patients receive regular treatment for 8 to ten weeks, five days a week. That means a time commitment of several hours a day for up to two months. Radiation has complications, too, including diarrhea and erectile dysfunction.

What's a guy to do? "The best treatment is the one that the informed patient feels comfortable with," says Jang. Then you can lay to rest the suspicion that you're just getting the treatment that's best for your doctor's business, not for you.

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