Early intervention for prostate cancer can theoretically cure a potentially
disabling and deadly disease. However, evidence suggests that this approach
may not improve survival and quality of life and may result in adverse effects.
Therefore, men with clinically localized prostate cancer face difficult decisions
regarding the management of their disease. To guide them in choosing between
treatment options, patients seek information and recommendations from physicians.
The article by Fowler and colleagues1
in this issue of THE JOURNAL suggests that urologists and radiation oncologists
in the United States more commonly recommend interventions that they provide
rather than accurately disseminating information about the uncertainty regarding
the risks and benefits of early detection and treatment of prostate cancer.
Based on a survey designed to assess clinicians' beliefs and practices regarding
prostate cancer management, nearly all respondents recommended prostate-specific
antigen (PSA) testing for men aged 50 to 74 years. In men with a life expectancy
of less than 10 years (ie, older than age 75 years), routine PSA testing was
still recommended by 43% of radiation oncologists and 16% of urologists. For
men with moderately differentiated, clinically localized cancer and greater
than a 10-year life expectancy, 93% of urologists recommended radical prostatectomy
whereas 72% of radiation oncologists recommended radiation. Furthermore, 82%
of radiation oncologists thought that radical prostatectomy was overused,
while 13% and 26% responded that external beam radiation and brachytherapy,
respectively, were overused. Conversely, 34% of urologists thought prostatectomy
was overused. Virtually none of the physicians recommended observation, except
for a small group of patients with low-grade tumors and a life expectancy
of less than 10 years.
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