The age of the urologist affects the postoperative care of prostate carcinoma patients

BACKGROUND. Strategies utilized by urologists in managing prostate carcinom a patients after radical prostatectomy vary appreciably. The reason for thi s is unclear. The authors investigated the effect of practitioner age on ma nagement strategies. METHODS. From among the total of 12,500 American Urological Association (AU A) members, 4467 were randomly selected to receive a custom-designed survey about their care of prostate carcinoma patients after radical prostatectom y. Respondents were asked to describe their follow-up practices for patient s treated with curative intent, their motivations regarding postoperative s urveillance, their methods of evaluating a postoperative increase in serum prostate specific antigen (PSA) level, and their choices of treatment for p atients with recurrent prostate carcinoma. RESULTS. One thousand fifty responses were analyzed. There was a statistica lly significant influence of practitioner age on the management of at-risk patients, but it was guile small. The typical workup for an elevated postop erative serum PSA level also varied significantly according to practitioner age; older urologists ordered more serum prostatic acid phosphatase levels and computed tomography scans of the abdomen and pelvis, whereas younger u rologists ordered more bone scans. The treatment of recurrent prostate carc inoma did not vary significantly according to urologist age. The opinions o f older urologists regarding the survival benefits of postoperative surveil lance were considerably different from the opinions of their younger collea gues. CONCLUSIONS, The results of this study suggest that urologist age accounts for some of the variation in the postoperative management of prostate carci noma patients. Differences in beliefs regarding the benefits of sun surveil lance may be partially responsible for this. Persuasive clinical research w ill probably be required to increase the uniformity of practice in this imp ortant area. Cancer 1999;86: 1314-21. (C) 1999 American Cancer Society.