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Doctors Like But Don’t Push Prostate Watching

October 15, 2012
Written by: , Filed in: Abdominal Imaging
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Most urologists and radiation oncologists say that active surveillance is an effective response to low-risk prostate cancer and that they’re comfortable recommending it.

But, strangely—or perhaps not so strangely—most say that “comfort” does not translate into actually recommending active surveillance.

Simon P. Kim, MD, of Mayo Clinic in Rochester, Minnesota, is lead author of a study that drew the above conclusions. Dr. Kim offered the following not exactly startling comment:

Our results may explain in part the relatively low use of active surveillance for low-risk prostate cancer in the United States.

He was quoted in a Mayo news release. He also presented the study findings Friday at the North Central Section of the American Society of Clinical Oncology Annual Meeting in Chicago.

A mail survey of 322 U.S. urologists and 321 radiation oncologists found that 77 percent of the urologists and 67 percent of the radiation oncologists said active surveillance (regular tests to monitor the tumor but no treatment unless the cancer becomes more aggressive) was effective for low-risk cases of prostate cancer.

The survey found that 74 percent of the urologists and 61 percent of the radiation oncologists said they were comfortable recommending active surveillance. But of all those physicians, only 21 percent said they actually did so. Instead, they suggested radical prostatectomy (47 percent) or radiation therapy (32 percent). Not surprisingly, urologists were more likely to recommend surgery, and radiation oncologists were more likely to recommend radiation.

The survey didn’t address reasons for the gap between what the physicians thought about active surveillance and what they told patients about it. Some motivations undoubtedly were selfish; surveillance isn’t very lucrative. And some certainly were pragmatic; if patients have a disease, they want something done about it. Leaving cancer untreated understandably makes patients nervous. And there’s the whole “how can you be sure that my cancer really is ‘low-risk’?” issue.

Not that anybody asked us, but it seems that prostate cancer patients would benefit from more education about their disease. And maybe doctors would too.

* * *

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