Study: Most doctors do not recommend active surveillance of prostate cancer at low risk -
Instead, they recommend treatment by their specialty suggests the investigation in medical care
specialists who treat prostate cancer agree that active surveillance is an option, yet most do not recommend it, as appropriate for their own patients, according a study in the July issue of Medical Care effective. The journal is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.
On the contrary, urologists are more likely to recommend surgery and radiation oncologists are more likely to recommend radiation therapy treatments provided by their own specialties. "Given the growing concerns about the overtreatment of prostate cancer, our study has important policy implications of possible obstacles to the promotion of surveillance and specialty assets prejudices about the optimal treatment regarding prostate cancer localized "comments Dr. Simon P. Kim of Yale School of Medicine.
most experts prostate rate Effectiveness active surveillance
the researchers surveyed urologists and oncologists regarding their views on options for "low risk" prostate cancer. the study focused on the perception of active surveillance as a first approach.
prostate cancer usually progresses slowly most elderly men diagnosed with the disease at an early stage will not actually die from prostate cancer. for these low-risk cases, there is a growing interest in active surveillance, in which patients are monitored closely for signs of disease progression.
Active surveillance has emerged as an approach to avoid "over-treatment" of prostate cancer. In many cases, it can avoid surgery or radiation which would cause a risk of complications and side effects without actually benefiting the patient.
Dr Kim and coauthors analyzed survey responses from 717 US urologists and radiation oncologists. According to research data, 72 percent of experts agreed that active surveillance is an effective alternative for men with cancer of low risk prostate. In addition, 80 percent agreed that active surveillance has been underutilized in the United States.
-But do not recommend it for their own patients
"However, 71 percent of physicians reported that their patients are not interested in active surveillance" the researchers write. the rate was over 80 percent for radiation oncologists, compared to 60 percent for urologists.
When asked what treatment they recommend a hypothetical 60 the man with prostate cancer at low risk, only 22 percent of the doctors said would approve active surveillance. instead, 45 percent would recommend surgery (radical prostatectomy), while 35 percent would recommend some form of radiation therapy.
in general, the recommendations divided along the respondents-the lines most specialized recommended treatment under their specialty. After adjustment for other factors, urologists were four times more likely to recommend surgery, compared to radiation oncologists. Urologists are also much less likely to recommend a form of radiotherapy.
urologists were twice as likely to recommend active surveillance compared with radiation oncologists. The doctors who worked in academic medical centers were also more likely to recommend active surveillance.
The survey adds to recent evidence that physicians consider active surveillance as a "reasonable approach" for initial therapy in appropriate patients with low risk prostate cancer. The two specialist groups recognize the growing concern about overtreatment of prostate cancer.
However, "that does not always translate into their self-reported treatment recommendations patterns," Dr. Kim and colleagues write. "Our study suggests that there are still key attitudinal barriers to active surveillance among specialists in prostate cancer, especially given radiation oncologists and urologists can see their treatment as superior."
The researchers discuss options to better incorporate patient preferences into treatment decisions such as decision aids provide men with evidence on the benefits and disadvantages of the treatment options. Coordinated, multidisciplinary care involving the patient's primary care providers and specialists can also provide a better balance between the risks and benefits of different approaches. "By doing so, active monitoring can become a more acceptable disease management strategy for cancer of low risk prostate patients and newly diagnosed specialists," Dr. Kim and coauthors conclude.
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