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Editorial |

Uncertainty in Prostate Cancer Care The Physician's Role in Clearing the Confusion

Timothy J. Wilt, MD, MPH
JAMA. 2000;283(24):3258-3260. doi:10.1001/jama.283.24.3258.
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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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