Radiation oncologists and urologists in Florida are more aggressive in screening and treating men 75 years and older for prostate cancer than their colleagues in other parts of the country, according to a study supported by the Agency for Healthcare Research and Quality (HS08397). Researchers led by Mary McNaughton Collins, M.D., M.P.H., and Michael J. Barry, M.D., of Massachusetts General Hospital, surveyed a random sample of radiation oncologists and urologists in the United States in 1998 to determine their beliefs about prostate cancer screening and treatment. A total of 559 radiation oncologists (76 percent) and 504 urologists (64 percent) responded to the survey.
Even though prostate-specific antigen (PSA) screening of men is not recommended for men with limited life expectancy (since they are more likely to die from other causes than slow-growing prostate cancer), 92 percent of Florida radiation oncologists recommended PSA screening of men aged 75 to 79 more than one-half of the time compared with 68 to 81 percent of radiation oncologists in other States. Comparable figures for urologists were 84 percent of Florida urologists versus 42 to 53 percent of urologists in other States.
In addition, the Florida physicians were more likely to treat at least 20 percent of their patients with brachytherapy (short-distance radiation), considered a primary therapy for prostate cancer, and to believe it had survival value for men with a life expectancy of less than 10 years. There were no regional differences in physician beliefs about the survival value of radical prostatectomy (surgical removal of the prostate). More Florida radiation oncologists (but not urologists) than those from other States recommended early androgen deprivation therapy for a rising PSA after both radiotherapy and surgery. However, the value of this therapy, which can cause fatigue and emotional distress, has not been documented. The higher concentration of older patients in Florida may pressure doctors in that State to give older men more care than is offered to men in other States. Nevertheless, the value of this more aggressive approach is unproven, caution the researchers.
See "United States radiation oncologists' and urologists' opinions about screening and treatment of prostate cancer vary by region," by Drs. Collins and Barry, Anthony Zietman, M.D., and others, in the October 2002 Urology 60(4), pp. 628-633.
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