Complex treatment choices for men with prostate cancer

Men diagnosed with prostate cancer have many treatment options – surgery, radiation (beam or seed implants), hormone therapy, or watchful waiting. And according to a study in the current issue of the Archives of Internal Medicine the treatment they choose has a lot to do with the type of specialist they consult.

Researchers analyzed the records of 85,000 Medicare beneficiaries and found that those who saw a urologist – a surgical specialist – chose surgery 40 percent of the time and hormone therapy 27 percent of the time. Only 5 percent of this group of men got radiation and 34 percent chose watchful waiting. On the other hand, 83 percent of the men who went to both a urologist and a radiation oncologist chose radiation compared with 8 percent who had an operation.

The men who returned to consult with their primary care physician were more likely to forego aggressive treatment in favor of watchful waiting. In fact, 58 percent of the youngest and healthiest of the men – those considered prime candidates for surgery or radiation – who returned to see their family doctor decided against aggressive treatment in favor of watchful waiting.

The researchers speculated that primary care doctors might be more willing than specialists to consider watchful waiting. Alternatively, they suggested those men who were not good candidates for aggressive treatment may have been more likely to be referred back to their primary care doctors.

Still, Thomas L. Jang, a co-author of the study and now at the Cancer Institute of New Jersey in New Brunswick told my colleague Don Sapatkin that the research suggested that "a primary care doctor can be a valuable resource" for men diagnosed with prostate cancer.