Closely Watching Low-Risk Prostate Cancer May Be Best Approach

Prostate cancer treatments like radiation therapy could cause more harm than good as compared to simple observation

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) A patient's choice of doctor can go a long way towards developing a personal and professional relationship. But that selection could also play a part in what kind of treatment the physician recommends.

A new study has highlighted a wide variation in treatment when it comes to low-risk prostate cancer.

According to this study, recent medical school graduates were more likely than more seasoned health care professionals to suggest observation instead of radiation therapy or removal of the prostate.

These potentially unnecessary treatments might cause dangerous complications that would not occur with observation.

"Talk to a urologist about how to best manage prostate cancer."

Karen Hoffman, MD, MHSc, of the University of Texas MD Anderson Cancer Center in Houston, Texas, led this research.

The researchers set out to analyze whether men with low-risk prostate cancer, meaning the condition probably won’t cause symptoms or affect survival if left untreated, should receive potentially complicating treatment or be subject to close observation instead.

Radiation therapy is a common treatment for prostate cancer, but it can also cause urinary problems, rectal bleeding and impotence.

The prostate is a walnut-sized gland that makes fluid for semen, which carries sperm in men. Prostate cancer is a slow-growing and common form of cancer that can spread to other parts of the body.

Dr. Hoffman and her team studied 2,145 urologists who diagnosed low-risk prostate cancer in 12,068 men 66-years-old and older between 2006 and 2009.

Of that group 80.1 percent received treatment and 19.9 percent were observed.

Depending on the urologist, observation varied from 4.5 percent of low-risk prostate cancer patients to 64.2 percent of patients.

Less recent medical school graduates were less likely to recommend observation for low-risk patients, instead opting for treatment including radiation and prostatectomy, in which the gland is removed.

With the subset of doctors who diagnose prostate cancer and perform medical interventions like radiation therapy, patients were more likely to receive the treatment instead of observation.

Essentially, the researchers found that choice in physician was a primary factor influencing the treatment.

"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," the study authors wrote.

“There is a meaningful physician-level variation in the management of low-risk prostate cancer. Public reporting of physicians’ cancer management profiles would enable primary care physicians and patients to make more informed decisions when selecting a physician to diagnose and manage prostate cancer," they wrote.

This study was published online July 14 in JAMA Internal Medicine.

Funding was provided by MD Anderson, the National Cancer Institute, the Cancer Prevention and Research Institution of Texas, the Duncan Family Institute, the McCombs Institute Center for Radiation Oncology Research and the American Cancer Society.

Dr. Hoffman disclosed receiving funding from the American Society for Radiation Oncology, and a co-author disclosed receiving research support from a private company.

Review Date: 
July 14, 2014
Last Updated:
July 14, 2014