For men with low-risk prostate cancer, a consultation with a medical oncologist may help reduce the odds of overtreatment, according to a recent study by Aizer and colleagues, published in the Journal of Oncology Practice.1
Numerous treatment options are available for low-risk prostate cancer, including radical prostatectomy, external-beam radiation therapy, brachytherapy, and active surveillance. Clinical guidelines recommend active surveillance, which involves regular monitoring for disease progression and initiation of therapy when clinically significant progression occurs, because the 10-year survival rate of 97% for low-risk prostate cancer makes surveillance as effective as other treatment options, at a substantially lower cost.2,3
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Nevertheless, only 5% to 9% of men with low-risk prostate cancer choose active surveillance, suggesting widespread overtreatment of this common cancer. One possible reason that so few men choose active surveillance is that most consult a urologist and/or a radiation oncologist, both of whom are more likely to recommend the treatment they themselves provide, a phenomenon known as “specialist bias”.4
Getting a Third Opinion
Medical oncologists rarely treat low-risk prostate cancer and therefore might have a more objective point of view on the best treatment option. To determine whether consultation with a medical oncologist increases the use of active surveillance, a research team from Harvard Medical School reviewed the records of 188 men with low-risk prostate cancer who had consulted multiple specialists. All patients had a Gleason score of 6 or lower, prostate-specific antigen less than 10 ng/mL, and clinical tumor classification of T1c or T2a.1
Eighty-one patients consulted with a medical oncologist. In addition, 166 patients consulted with a urologist and 128 with a radiation oncologist. No demographic factors were identified that predicted a consultation with any of these specialists.
The researchers found that significantly more patients who consulted with a medical oncologist chose active surveillance than those patients who did not (37% vs. 21%; P=0.01).
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Older patients were also more likely to choose active surveillance, whereas those with a high percentage of positive cores on biopsy were less likely to do so. Low-risk patients with a life expectancy less than 10 years and very low-risk patients with a life expectancy of less than 20 years were both more likely to choose active surveillance if they consulted with a medical oncologist.
To a Hammer, Everything Looks Like a Nail
In their discussion, the study authors point out that specialist bias is well documented—in surveys, urologists and radiation oncologists have been found to overwhelmingly recommend the type of therapy they provide. No doubt, their recommendations are sincere, because they would treat themselves no differently. When asked how they would want to be treated if they were diagnosed with prostate cancer, 79% of urologists stated that they would choose radical prostatectomy and 92% of radiation oncologists chose—you guessed it—radiation therapy.5
For other men with low-risk prostate cancer, a visit to a medical oncologist is recommended.
- Aizer AA, Paley JJ, Michaelson MD, et al. Medical oncology consultation and minimization of overtreatment in men with low-risk prostate cancer. J Oncol Pract. 2014 Jan 7 [Epub ahead of print].
- Klotz L, Zhang L, Lam A, et al. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol. 2010;28(1):126-131.
- Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203-213.
- Jang TL, Bekelman JE, Liu Y, et al. Physician visits prior to treatment for clinically localized prostate cancer. Arch Intern Med. 2010;170(5):440-450.
- Moore MJ, O’Sullivan B, Tannock IF. How expert physicians would wish to be treated if they had genitourinary cancer. J Clin Oncol. 1988;6(11):1736-1745.