Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions.
OBJECTIVE
This study describes urologist recommendations for treatment among local-stage prostate cancer patients presenting for initial management consultations versus second opinions. We hypothesized that urologists present a wider range of management recommendations and are less likely to consider the patient preference during the initial consultation.


METHODS
Newly diagnosed local-stage prostate cancer patients and their urologists participated in a survey at urology practices in three states. The urologist's survey included questions about the patient's clinical status, treatments discussed and recommended, and factors that influenced the urologist's recommendations.


RESULTS
Of the 238 eligible patients, 95 men presented for an initial consultation, and 143 men presented for a second opinion. In multivariate analysis, urologists recommended 0.52 more treatments (standard error 0.19, P<0.001) during an initial consultation as opposed to a second opinion. The proportion recommending surgery increased from 71-91% (initial consultation versus second opinion setting). Among initial consultations, 59% had low-risk disease, and urologists' recommendations included surgery (80%), external radiation (38%), brachytherapy (seeds) (52%), and active surveillance (25%). Of the 54% with low-risk disease in a second opinion consultation, urologists' recommendations included surgery (90%), external radiation (16%), brachytherapy (14%), and active surveillance (16%).


CONCLUSIONS
In second opinion settings urologists discussed fewer treatment options and recommended surgery more often. These findings also applied to men with low-risk prostate cancer.
Ramsey
Scott D
SD
Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, M3-B232, Seattle, WA 98109-1024, USA. sramsey@fhcrc.org
Zeliadt
Steven B
SB
Fedorenko
Catherine R
CR
Blough
David K
DK
Moinpour
Carol M
CM
Hall
Ingrid J
IJ
Smith
Judith Lee
JL
Ekwueme
Donatus U
DU
Fairweather
Megan E
ME
Thompson
Ian M
IM
Keane
Thomas E
TE
Penson
David F
DF
D000368:Aged; D001918:Brachytherapy; D003625:Data Collection; D004358:Drug Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D012017:Referral and Consultation / Q000639:trends*; D013038:Specialization; D014572:Urology; D057832:Watchful Waiting