RT commonly prescribed regardless of Ca stage, PSA level

A recent UCLA study suggests that physicians need to improve treatment counseling for patients with prostate cancer, a leading expert says.

Radiation therapy is often prescribed to prostate cancer patients regardless of cancer stage, PSA level, cancer grade, or the patient’s life expectancy. And referral to a radiation oncologist is the most significant predictor of whether or not these patients receive radiation therapy, according to a recent study that one expert says speaks to poor patient counseling by physicians.

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In the study, published online in JAMA Oncology (Feb. 19, 2015), UCLA researchers analyzed claims data from more than 37,000 patients from 2004 to 2007.

Among their findings:

Fifty-eight percent of prostate cancer patients were treated with radiation therapy.

Most patients who were referred to radiation oncologists had radiation therapy, including those of advanced age and with significant coexisting morbidities.

The next most commonly performed procedure for prostate cancer was radical prostatectomy, at 19%, followed by watchful waiting or active surveillance at 10%.

“Doctors and patients view radiation as safe. Men fighting this disease don’t always need radiation or surgery as their only choice,” said first author Karim Chamie, MD, in a UCLA press release.

Next: What Dr. Chamie's team discovered

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Dr. Chamie’s team discovered that radiation therapy was the most commonly recommended treatment regardless of cancer stage or grade, PSA level, or patient life expectancy. The most significant predictor of a man receiving radiation therapy was referral to a radiation oncologist. Conversely, urologists and surgeons significantly incorporated the age and health of the patient as well as the aggressiveness of the cancer when recommending surgery.

By 2 years after radiation, men often start to suffer side effects, said Dr. Chamie, including urinary incontinence, bowel dysfunction, erectile dysfunction, hematuria, and radiation cystitis.

The authors concluded that more research needs to be done to better determine what drives decision-making recommendations for prostate cancer patients.

Urology Times Editorial Consultant J. Brantley Thrasher, MD

Urology Times Editorial Consultant J. Brantley Thrasher, MD, of the University of Kansas Medical Center in Kansas City, wrote in an email to Urology Times that the study speaks to the fact that many physicians continue to do a poor job of doing comprehensive counseling for their patients with prostate cancer.

“All of the patient's comorbidities, life expectancy, age, and many other factors have to be used in the counseling and decision-making. One treatment is certainly not right for all patients. The fastest growing group of patients in my practice are those who choose active surveillance. I still think it is underutilized, in the U.S. especially. We use our website, handouts, pamphlets, and one-on-one counseling for these patients in a very comprehensive fashion to aid them in their decision-making,” wrote Dr. Thrasher, who was not involved with the study.

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