Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer

Context Multiple treatment options are available for men with prostate canc er, but therapeutic recommendations may differ depending on the type of spe cialist they consult. Objective To define and contrast the distribution of management recommendat ions by urologists and radiation oncologists for a spectrum of men with pro state cancer. Design, Setting, and Participants Mail survey sent in 1998 to a random samp le of physicians in the United States, who were listed as urologists (respo nse rate 64%, n = 504) and radiation oncologists (response rate 76%, n=559) in the American Medical Association Registry of Physicians and practicing at least 20 hours per week. Main Outcome Measure Questionnaire addressing beliefs and practices regardi ng prostate cancer management. Results Forty-three percent of radiation oncologists vs 16% of urologists w ould recommend routine prostate-specific antigen testing for men aged 80 ye ars and older. For men with moderately differentiated, clinically localized cancers, and a more than 10-year life expectancy, 93% of urologists chose radical prostatectomy as the preferred treatment option, while 72% of radia tion oncologists believed surgery and external beam radiotherapy were equiv alent treatments. For most tu mor grades and prostate-specific antigen leve ls, both specialty groups were significantly more likely to recommend the t reatment in their specialty than the other treatment, Both groups reported giving patients similar estimates of the risks of complications due to surg ery and radiation. Neither group favored watchful waiting In their treatmen t management except for a subset of men with life expectancies of less than 10 years and cancers with very favorable prognoses (Gleason score of 3 or 4 and prostate-specific antigen level less than or equal to 5 ng/mL), Conclusions Based on this study, while urologists and radiation oncologists do agree on a variety of issues regarding detection and treatment of prost ate cancer, specialists overwhelmingly recommend the therapy that they them selves deliver.