Physician visits prior to treatment for clinically localized prostate cancer.
BACKGROUND
The 2 primary therapeutic interventions for localized prostate cancer are delivered by different types of physicians, urologists, and radiation oncologists. We evaluated how visits to specialists and primary care physicians (PCPs) by men with localized prostate cancer are related to treatment choice.


METHODS
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified 85 088 men with clinically localized prostate cancer diagnosed at age 65 years or older, between 1994 and 2002. Men were categorized by primary treatment received within 9 months of diagnosis: radical prostatectomy (n = 18 201 [21%]), radiotherapy (n = 35 925 [42%]), androgen deprivation (n = 14 021 [17%]), or expectant management (n = 16 941 [20%]). Visits to specialists and PCPs were analyzed by patient characteristics and primary therapies received and were identified using Medicare claims and the American Medical Association Physician Masterfile.


RESULTS
Overall, 42 309 men (50%) were seen exclusively by urologists, 37 540 (44%) by urologists and radiation oncologists, 2329 (3%) by urologists and medical oncologists, and 2910 (3%) by all 3 specialists. There was a strong association between the type of specialist seen and primary therapy received. Visits to PCPs were infrequent between diagnosis and receipt of therapy (22% of patients visited any PCP and 17% visited an established PCP) and were not associated with a greater likelihood of specialist visits. Irrespective of age, comorbidity status, or specialist visits, men seen by PCPs were more likely to be treated expectantly.


CONCLUSIONS
Specialist visits relate strongly to prostate cancer treatment choices. In light of these findings, prior evidence that specialists prefer the modality they themselves deliver and the lack of conclusive comparative studies demonstrating superiority of one modality over another, it is essential to ensure that men have access to balanced information before choosing a particular therapy for prostate cancer.
Jang
Thomas L
TL
Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, New York, USA. jangtl@umdnj.edu
Bekelman
Justin E
JE
Liu
Yihai
Y
Bach
Peter B
PB
Basch
Ethan M
EM
Elkin
Elena B
EB
Zelefsky
Michael J
MJ
Scardino
Peter T
PT
Begg
Colin B
CB
Schrag
Deborah
D
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000726:Androgen Antagonists / Q000627:therapeutic use; D002755:Choice Behavior; D015986:Confounding Factors, Epidemiologic; D005194:Family Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology; D006278:Medicare; D009367:Neoplasm Staging; D009819:Office Visits / Q000706:statistics & numerical data*; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D018787:Radiation Oncology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012107:Research Design; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D014572:Urology; D000078329:Workforce
D000726:Androgen Antagonists