Variation in Treatment Recommendations of Adjuvant Radiation Therapy for High-risk Prostate Cancer by Physician Specialty
Kim SP, Tilburt JC, Karnes RJ, Ziegenfuss JY, Han LC, Shah ND, Frank I, Smaldone MC, Gross CP, Yu JB, Trinh QD, Sun M, O'Malley RL, Nguyen PL. Urology. 2013 Aug 1. pii: S0090-4295(13)00718-8. doi: 10.1016/j.urology.2013.04.060. [Epub ahead of print]

Source

Department of Urology, Yale University, New Haven, CT. Electronic address: simon.p.kim@yale.edu.

Abstract

OBJECTIVE:

To assess the treatment recommendations from a nationally representative sample of radiation oncologists and urologists on adjuvant radiotherapy for patients with pathologically advanced prostate cancer after radical prostatectomy.

METHODS:

From a random sample of 1422 physicians (n = 711 radiation oncologists; n = 711 urologists) in the American Medical Association Masterfile, a mail survey queried treatment recommendations for adjuvant radiotherapy that varied by the following pathologic features: extraprostatic extension (pT3a) vs seminal vesicle invasion (pT3b), Gleason 7 vs Gleason 8-10, and margin negative (MN) vs margin positive (MP). Pearson chi-square and multivariable logistic regression were used to test for differences in treatment recommendations by physician specialty.

RESULTS:

Response rates for radiation oncologists and urologists were similar (44% vs 46%; P = .42). Radiation oncologists were more likely to recommend adjuvant radiotherapy than urologists for all the varying pathologic scenarios from pT3a, Gleason 7, and MN (42.5% vs 9.7%; adjusted odds ratio [OR]: 7.82, P <.001) to pT3b, Gleason 8-10, and MP disease (94.5% vs 89.1%, adjusted OR: 2.46, P <.001). Compared with radiation oncologists, urologists were more likely to recommend salvage radiotherapy pT3a, Gleason 7, and MN (90.3% vs 57.7%; adjusted OR: 7.72, P <.001) to pT3b, Gleason 8-10, and MP disease (10.9% vs 5.5%; adjusted OR: 2.22, P <.001).

CONCLUSION:

In this national survey, radiation oncologists and urologists have markedly different treatment recommendations for adjuvant and salvage radiotherapy. Patients with adverse pathologic features after radical prostatectomy should consult with both a urologist and radiation oncologist to hear a diversity of opinions to make the most informed decision possible.