Doctors biased in prostate cancer treatment: study

The type of prostate cancer treatment a man gets has a lot to do with the kind of specialist he sees first, according to a study released on Monday that lends scientific evidence to something many men have likely guessed.
Prostate cancer can be treated effectively using radiation, radioactive seeds or surgical removal of the prostate. Surgery or drugs to stop production of testosterone, known as hormone therapy, may also be used in high-risk patients.
Doctors often also advise close medical observation, also known as watchful waiting.
Each treatment is associated with different benefits and side effects. Prostate surgery can cause urinary incontinence and erectile dysfunction; radiation therapy can cause diarrhea and erectile dysfunction; and hormone therapy can cause hot flashes and breast tenderness.
"You want your physician to convey this information without a bias," Dr. Thomas Jang, a urologist from Memorial Sloan-Kettering Cancer Center in New York, said at the annual meeting of the American Society of Clinical Oncologists.
Although the 5-year survival rate for men with localized prostate cancer is nearly 100 percent, it is the third most common cause of cancer death in men of all ages, and the most common cause of cancer death in men over 75.
No scientific studies have proven which therapy works best, so men typically follow their doctor's recommendation, said Jang.
The study of more than 85,000 men aged 65 and older with prostate cancer that had not yet spread uncovered a strong correlation between physician type and treatment.
If a man's doctor happens to be a urologist, for example, the recommendation for men under 70 most often will be surgery -- 70 percent of the time. For men over 75 who saw only a urologist, the choice was watchful waiting or hormone therapy in 91 percent of the patients.
But if they saw both a urologist and a radiation oncologist, 78 percent of younger men and 85 percent of older men got radiation therapy.
Because patients tend to fare well on all the treatment options, the choice comes down to which side effects and treatment options best fit the patient, Dr. Justin Bekelman, a radiation oncologist at Memorial Sloan-Kettering, who worked on the study, said in an interview.
"It's not enough to say, Google it and check it out," he said.
Most prostate cancer patients tend to see a urologist first because they are the doctors who perform biopsies and make diagnoses.
"I think urologists as gatekeepers have to present balanced information," Jang said.
The American Cancer Society expects 218,890 U.S. men to be diagnosed with prostate cancer in 2007 and 27,000 to die of it.