World Journal of Urology

, Volume 29, Issue 1, pp 3–9

Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions

  • Scott D. Ramsey
  • Steven B. Zeliadt
  • Catherine R. Fedorenko
  • David K. Blough
  • Carol M. Moinpour
  • Ingrid J. Hall
  • Judith Lee Smith
  • Donatus U. Ekwueme
  • Megan E. Fairweather
  • Ian M. Thompson
  • Thomas E. Keane
  • David F. Penson
Topic Paper

DOI: 10.1007/s00345-010-0602-y

Cite this article as:
Ramsey, S.D., Zeliadt, S.B., Fedorenko, C.R. et al. World J Urol (2011) 29: 3. doi:10.1007/s00345-010-0602-y

Abstract

Objectives

This study describes urologist recommendations for treatment among local-stage prostate cancer patients presenting for initial management consultations versus second opinions. We hypothesized that urologists present a wider range of management recommendations and are less likely to consider the patient preference during the initial consultation.

Methods

Newly diagnosed local-stage prostate cancer patients and their urologists participated in a survey at urology practices in three states. The urologist’s survey included questions about the patient’s clinical status, treatments discussed and recommended, and factors that influenced the urologist’s recommendations.

Results

Of the 238 eligible patients, 95 men presented for an initial consultation, and 143 men presented for a second opinion. In multivariate analysis, urologists recommended 0.52 more treatments (standard error 0.19, P < 0.001) during an initial consultation as opposed to a second opinion. The proportion recommending surgery increased from 71–91% (initial consultation versus second opinion setting). Among initial consultations, 59% had low-risk disease, and urologists’ recommendations included surgery (80%), external radiation (38%), brachytherapy (seeds) (52%), and active surveillance (25%). Of the 54% with low-risk disease in a second opinion consultation, urologists’ recommendations included surgery (90%), external radiation (16%), brachytherapy (14%), and active surveillance (16%).

Conclusions

In second opinion settings urologists discussed fewer treatment options and recommended surgery more often. These findings also applied to men with low-risk prostate cancer.

Keywords

Prostate cancer Decision making Second opinions Urologist 

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Scott D. Ramsey
    • 1
  • Steven B. Zeliadt
    • 2
    • 3
  • Catherine R. Fedorenko
    • 1
  • David K. Blough
    • 3
  • Carol M. Moinpour
    • 1
  • Ingrid J. Hall
    • 4
  • Judith Lee Smith
    • 4
  • Donatus U. Ekwueme
    • 4
  • Megan E. Fairweather
    • 1
  • Ian M. Thompson
    • 5
  • Thomas E. Keane
    • 6
  • David F. Penson
    • 7
  1. 1.Fred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of Veterans Affairs Medical CenterSeattleUSA
  3. 3.University of WashingtonSeattleUSA
  4. 4.Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA
  5. 5.University of Texas Health Science Center at San AntonioSan AntonioUSA
  6. 6.Medical University of South CarolinaCharlestonUSA
  7. 7.Vanderbilt University Medical CenterNashvilleUSA

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