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.
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Acknowledgments
This publication was supported by Cooperative Agreement Number 1-U48-DP-000050 from the Centers for Disease Control and Prevention, Prevention Research Centers Program, through the University of Washington Health Promotion Research Center. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Additional support for the UTHSCSA program was provided by funding from the National Cancer Institute Cancer Center Support Grant (CA054174). Case ascertainment for the focus group research was supported by the Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by Contract No. N01-PC-35142 from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center and the State of Washington.
Conflict of interest
Drs. Ingrid Hall, Judith Lee Smith, and Donatus Ekwueme are employees of the Centers for Disease Control and Prevention (CDC), the primary funding agency for this research. Other authors have no conflicts of interest pertaining to the information reported in this manuscript.
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Ramsey, S.D., Zeliadt, S.B., Fedorenko, C.R. et al. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. World J Urol 29, 3–9 (2011). https://doi.org/10.1007/s00345-010-0602-y
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DOI: https://doi.org/10.1007/s00345-010-0602-y