"It's not that surprising or unique" since most doctors are probably biased towards their own specialty, and likely do believe their therapy is the best, noted Dr. Timothy J. Wilt, an internist and epidemiologist at the Minneapolis VA Center for Chronic Disease Outcomes Research in Minnesota. "It's somewhat disappointing that they recommend more what they have to offer than what evidence suggests."
The study comparing recommendations of 504 urologists and 559 radiation oncologists (cancer specialists) is published in the June 28th issue of The Journal of the American Medical Association (JAMA).
In the study, Dr Floyd Fowler and colleagues at the University of Massachusetts in Boston found that while specialists advocated for their own specialty, there were many issues both specialists agreed on, such as routine prostate-specific antigen (PSA) testing in men until at least age 75, and treating patients rather than waiting to see what develops over time. Because prostate cancer may grow very slowly in older patients, sometimes doctors advise a "wait and see" approach when it is found in elderly men.
The majority of physicians in both specialties believe that radical prostate surgery, external beam radiotherapy and brachytherapy (treatment with ionizing radiation) increase survival, despite lack of trials proving this to be true.
Furthermore, the physicians agreed that patients with less than a 10-year life expectancy were unlikely to benefit from therapy for prostate cancer since the cancer often progresses slowly.
The authors concluded that meeting with a member of each specialty may be the way to ensure patients receive balanced information on what treatment option to follow.
Neither group of specialists advocate for expectant management--waiting to see how the cancer progresses before opting for therapy, although studies show that when patients learn the advantages and risks associated with therapy, a substantial minority would choose to wait and see.
"The majority of men die with, rather than from their condition," explained Wilt, who wrote an editorial discussing the uncertainties of treatment for prostate cancer in the same issue of JAMA. There is a dearth of good randomized clinical trials to resolve the issue of best treatment for prostate cancer patients, he said.
Without these trials, any option now available "is similar to flipping a coin," Wilt told Reuters Health. "The reason there are options is that nothing has been shown to be superior to another."
Wilt recommends that physicians provide unbiased information on the benefits and risks of all treatment options to their patients. He also advocates encouraging participation in trials, since any treatment group a patient falls into is, for now at least, as good as any other and more participation in trials will eventually supply the answers clinicians need.
SOURCE: The Journal of the American Medical Association (JAMA) 2000, 283: 3217-3222.