ASTRO, AAFP Choosing Wisely lists target prostate cancer, urinary tract infection

The American Society for Radiation Oncology (ASTRO) and the American Academy of Family Physicians (AAFP) have both released recommendations on the diagnosis and treatment of prostate cancer as part of the Choosing Wisely campaign.

The AAFP also weighed in on the use of voiding cystourethrogram in febrile pediatric urinary tract infection.

Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, is designed to encourage clinicians and patients to scale back medical tests and procedures that may be unnecessary and even potentially harmful. The AUA announced its own recommendations earlier this year.

Among ASTRO’s five items for the initiative were these prostate cancer-related recommendations:

• Don’t initiate management of low-risk prostate cancer without discussing active surveillance. “Shared decision making between the patient and the physician can lead to better alignment of patient goals with treatment and more efficient care delivery,” according to an ASTRO statement.

• Don’t routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry. “There is no clear evidence that proton beam therapy for prostate cancer offers any clinical advantage over other forms of definitive radiation therapy,” ASTRO said.

The AAFP’s most recent group of Choosing Wisely recommendations, its third such list, includes a statement reinforcing the organization’s support of the May 2012 recommendation of the U.S. Preventive Services Task Force against performing PSA-based screening for prostate cancer in asymptomatic men.

“For PSA screening in men without symptoms, the data is extremely clear that the test provides very little benefit for patients, along with a significant risk of harm from the diagnostic procedures and the treatments that are performed," said AAFP President-elect Reid Blackwelder, MD.

The AAFP also said physicians should not perform voiding cystourethrogram routinely in first febrile urinary tract infection in children aged 2-24 months. “The risks associated with radiation (plus the discomfort and expense of the procedure) outweigh the risk of delaying the detection of the few children with correctable genitourinary abnormalities until their second UTI,” the AAFP said in a statement.

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