Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions.

Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF
World J Urol. 2011 29 (1): 3-9

PMID: 20959991 · DOI:10.1007/s00345-010-0602-y

OBJECTIVES - This study describes urologist recommendations for treatment among local-stage prostate cancer patients presenting for initial management consultations versus second opinions. We hypothesized that urologists present a wider range of management recommendations and are less likely to consider the patient preference during the initial consultation.

METHODS - Newly diagnosed local-stage prostate cancer patients and their urologists participated in a survey at urology practices in three states. The urologist's survey included questions about the patient's clinical status, treatments discussed and recommended, and factors that influenced the urologist's recommendations.

RESULTS - Of the 238 eligible patients, 95 men presented for an initial consultation, and 143 men presented for a second opinion. In multivariate analysis, urologists recommended 0.52 more treatments (standard error 0.19, P<0.001) during an initial consultation as opposed to a second opinion. The proportion recommending surgery increased from 71-91% (initial consultation versus second opinion setting). Among initial consultations, 59% had low-risk disease, and urologists' recommendations included surgery (80%), external radiation (38%), brachytherapy (seeds) (52%), and active surveillance (25%). Of the 54% with low-risk disease in a second opinion consultation, urologists' recommendations included surgery (90%), external radiation (16%), brachytherapy (14%), and active surveillance (16%).

CONCLUSIONS - In second opinion settings urologists discussed fewer treatment options and recommended surgery more often. These findings also applied to men with low-risk prostate cancer.

MeSH Terms (17)

Aged Brachytherapy Data Collection Drug Therapy Humans Male Middle Aged Neoplasm Staging Patient Preference Practice Patterns, Physicians' Prospective Studies Prostatectomy Prostatic Neoplasms Referral and Consultation Specialization Urology Watchful Waiting

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