Recommendations by Canadian urologists and radiation oncologists for the treatment of clinically localized prostate cancer

Abstract

Recommendations by Canadian urologists and radiation oncologists for the treatment of clinically localized prostate cancer ORIGINAL RESEARCH Abstract Objective: Previous work has shown that urologists and radiation oncologists prefer the treatment that they themselves deliver when treating clinically localized prostate cancer. Our objective was to determine whether Canadian radiation oncologists and urologists have similar biases in favour of the treatments that they themselves deliver for localized prostate cancer. Methods:We developed a survey to poll the beliefs that Canadian radiation oncologists and urologists held toward prostate specific antigen (PSA) screening, survival benefits of treatment, recommendations for treatment of prostate cancer and the likelihood of side effects with each therapy. Results:Urologists were more likely to recommend routine PSA screening for men up to age 70 (p < 0.001), while radiation oncologists were more likely to recommend PSA screening for men over age 80 (p < 0.04). More urologists felt that there was "definitely" a survival advantage with radical prostatectomy (RP) (60% v. 21%, p < 0.001). More radiation oncologists recommend external beam radiation therapy (EBRT) (p < 0.01) or brachytherapy (p < 0.03) to treat low-risk prostate cancer. More urologists than radiation oncologists recommend RP for intermediate-risk patients (98% v. 70%, p < 0.001). Conclusion:Most Canadian urologists and radiation oncologists recommend routine PSA screening for men aged 50 to 70. A significant preference was detected among both urologists and radiation oncologists for the treatment that they themselves deliver. While both urologists and radiation oncologists recommend prostatectomy for the treatment of low-risk localized prostate cancer, urologists are significantly less likely to recommend EBRT. Conversely, when patients present with intermediate-risk prostate cancer, radiation oncologists were significantly less likely than urologists to recommend a prostatectomy.

Challenging the 10-year rule: The accuracy of patient life expectancy predictions by physicians in relation to prostate cancer management

“…4 Interestingly, Pearce and colleagues found that most urologists recommend screening patients up to 70 years old, while most radiation oncologists continue screening past 80. 9 Contrarily, the U.S. Preventative Task Force currently advocates that patients over 75 years old should not be screened, 10 though this recommendation might soon change to recommend against screening at all, regardless of age. 11 leung et al…”

Challenging the 10-year rule: The accuracy of patient life expectancy predictions by physicians in relation to prostate cancer management

“…While most agencies either cite an inadequacy of information to choose a side or provide limited partial guidelines, agencies that do describe the screening test recommend that patients have at least a 10-year life expectancy for them to benefit from the screening; 80% of Canadian specialists concur with this cut-off. 9 Similarly, there has also been controversy over whether patients over a certain age should be screened at all. This is because of their lesser likelihood to fulfill this "10-year rule" and benefit from treatment, even though it has been shown that survival after initial diagnosis is on average 15 to 20 years.…”

“…4 Interestingly, Pearce and colleagues found that most urologists recommend screening patients up to 70 years old, while most radiation oncologists continue screening past 80. 9 Contrarily, the U.S. Preventative Task Force currently advocates that patients over 75 years old should not be screened, 10 though this recommendation might soon change to recommend against screening at all, regardless of age. leung et al…”

Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation

“…Moreover, without effective decision support, patients may be exposed to more costly options without any better outcomes [ 12 , 13 ]. Studies in Canada and the USA found that urologists and radiation oncologists often provide unbalanced information on options in favour of their own expertise, and they are not able to correctly guess men’s preferences [ 14 , 15 ]. Practice variations in age-standardized rates of surgery for prostate cancer are 32 to 57 % across Ontario, Canada [ 16 ].…”