Visits to urologists and radiation oncologists prior to treatment decision making for clinically localized prostate cancer (LCaP)

Abstract

6506 Background: The two primary therapies for LCaP are delivered by different types of physicians, urologists and radiation oncologists. We evaluated how visits to various specialists relate to treatment choice. Methods: Using data from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked program, we evaluated 85,088 men with LCaP aged 65 and older diagnosed between 1994 and 2002 who received either radical prostatectomy (n=18,201), radiotherapy (n=35,925), primary androgen deprivation therapy (n=14,021), or expectant management (n=16,941) within 9 months of diagnosis. Prostate cancer specialists were identified by Medicare claims or data from the AMA Physician Masterfile. Results: Table 1 shows a strong association between the different specialists consulted and primary therapy received. When men aged 65 to 69 saw only a urologist, 70% had a radical prostatectomy; when also seen by a radiation oncologist, 15% had a radical prostatectomy. We found greater than expected variation in the propensity of a particular urologist’s patients to undergo radiotherapy evaluation, suggesting that some men are seen by a radiation oncologist less frequently (and others more frequently) than would be explained by chance. Conclusions: Recognizing that prostate cancer specialists have different viewpoints on the most appropriate management strategy, it is imperative to ensure that all men have access to balanced information prior to definitive therapy. No significant financial relationships to disclose. [Table: see text]