Urologists a Key Factor in PCa Observation Underuse



ORLANDO, Fla.—Many older men with favorable-risk prostate cancer (PCa) can be managed safely with observation. Most patients eligible for this approach choose upfront treatment, however, and the diagnosing urologist is the most important factor influencing that decision, according to a new study presented at the annual Genitourinary Cancers Symposium.

Lead investigator Karen E. Hoffman, MD, MHSc, MPH, of The University of Texas M.D. Anderson Cancer Center in Houston, said she and her colleagues postulate that this may be because the diagnosing urologist has the first conversation with the patient regarding the severity of the cancer and the management options.

The study examined data from 17,468 patients who received care from 2,613 urologists. Sixty-four percent of patients had T1c PCa; 85% received upfront treatment and 15% were managed with observation. Even among men aged 80 years and older, 67% received upfront treatment.

The diagnosing urologist accounted for 16% of the variance in choice of observation versus active treatment, the study showed.

After adjusting for patient factors, office-based urologists were less likely to manage patients with observation than hospital-based urologists, and urologists trained outside the U.S. were less likely to manage patients with observation than U.S.-trained urologists. Results also showed that 54% of urologists had no patients being managed with observation, while 12% of urologists managed more than 40% of their patients with observation.

In addition, after adjusting for case mix, only 3.5% of urologists demonstrated a higher than average likelihood of managing their patients with observation: 47% of men diagnosed by these urologists were managed with observation.

“Our study suggests the diagnosing urologist has the potential to influence whether a patient selects active surveillance rather than definitive treatment,” Dr. Hoffman said.

The study looked at 2004-2007 data in the Surveillance, Epidemiology & End Results (SEER)-Medicare and Texas Cancer Registry-Medicare databases.

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