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Some With Prostate Cancer May Not Get Best Advice

Doctors suggest widely varying treatments; second opinion vital, experts say
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WebMD News from HealthDay

By Steven Reinberg

HealthDay Reporter

MONDAY, July 14, 2014 (HealthDay News) -- Many men may not be getting the best advice when it comes to managing low-risk prostate cancer, two new studies suggest.

In the first study, researchers found that most men are getting their prostate removed or undergoing radiation therapy when carefully watching the cancer may be just as effective without the risks and side effects of surgery or radiation.

"The variation of treatment of low-risk prostate cancer by physicians was striking," said lead researcher Dr. Karen Hoffman, an assistant professor at the University of Texas MD Anderson Cancer Center in Houston.

Hoffman added that the doctor who diagnoses the cancer has the biggest influence on what treatment the patient will choose.

"The diagnosing urologist influences a man's treatment fate. The urologist not only influences up-front treatment versus observation, but also the type of treatment," she said.

Hoffman found that doctors who were older were more likely to recommend surgery or radiation rather than observation. Moreover, men were more likely to have surgery or radiation therapy if their urologist did that procedure, she added.

The rate of observation as opposed to other treatments across urologists ranged from almost 5 percent to 64 percent of patients. For men diagnosed by radiation oncologists, the rate of observation also varied from 2 percent to 47 percent, Hoffman said.

There may be a financial incentive at work here, said Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston. He was not involved in the study.

"You make a diagnosis and there is a financial incentive in keeping the patient," he said. However, the urologist may also believe in treating the patient rather than choosing observation, he said.

D'Amico advises that any man diagnosed with prostate cancer get a second opinion. "With prostate cancer, there are options for treatment and sometimes surveillance is the right thing to do. So, men really need to get a second opinion in conjunction with their primary care physician, who knows their overall health and their wishes," he said.

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