Management of low-risk prostate cancer, which is unlikely to cause symptoms or affect survival if left untreated, differs greatly among physicians, according to a study published in JAMA Internal Medicine.
Two approaches are common when low-risk prostate cancer is diagnosed: treatment with prostatectomy or radiotherapy, or observation.
Authors analyzed data from a group of men aged 66 years or older with low-risk prostate cancer. A total of 2,145 urologists diagnosed low-risk prostate cancer in 12,068 men. The majority — 80.1 percent — of the patients received treatment; 19.9 percent were observed.
Across urologists, the case-adjusted rate of observation varied from 4.5 percent to 64.2 percent of patients, and the diagnosing urologist accounted for 16.1 percent of the variation in up-front treatment vs. observation. Rates of observation varied across consulting radiation oncologists from 2.2 percent to 46.8 percent.
"Patients whose diagnosis was made by urologists who treated prostate cancer were more likely to receive up-front treatment and, when treated, more likely to receive a treatment that their urologist performed," the authors concluded.
"We postulate that the diagnosing urologist plays an important role in treatment selection because he or she is the first to convey the diagnosis to the patient and discuss disease severity and management options," they wrote.
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