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Floyd J. Fowler, Jr, PhD; Mary McNaughton Collins, MD, MPH; Peter C. Albertsen, MD, MS; Anthony Zietman, MD; Diana B. Elliott, BA; Michael J. Barry, MD

JAMA. 2000;283:3217-3222.

Context  Multiple treatment options are available for men with prostate cancer, but therapeutic recommendations may differ depending on the type of specialist they consult.

Objective  To define and contrast the distribution of management recommendations by urologists and radiation oncologists for a spectrum of men with prostate cancer.

Design, Setting, and Participants  Mail survey sent in 1998 to a random sample of physicians in the United States, who were listed as urologists (response rate 64%, n=504) and radiation oncologists (response rate 76%, n=559) in the American Medical Association Registry of Physicians and practicing at least 20 hours per week.

Main Outcome Measure  Questionnaire addressing beliefs and practices regarding prostate cancer management.

Results  Forty-three percent of radiation oncologists vs 16% of urologists would recommend routine prostate-specific antigen testing for men aged 80 years and older. For men with moderately differentiated, clinically localized cancers, and a more than 10-year life expectancy, 93% of urologists chose radical prostatectomy as the preferred treatment option, while 72% of radiation oncologists believed surgery and external beam radiotherapy were equivalent treatments. For most tumor grades and prostate-specific antigen levels, both specialty groups were significantly more likely to recommend the treatment in their specialty than the other treatment. Both groups reported giving patients similar estimates of the risks of complications due to surgery and radiation. Neither group favored watchful waiting in their treatment management except for a subset of men with life expectancies of less than 10 years and cancers with very favorable prognoses (Gleason score of 3 or 4 and prostate-specific antigen level 5 ng/mL).

Conclusions  Based on this study, while urologists and radiation oncologists do agree on a variety of issues regarding detection and treatment of prostate cancer, specialists overwhelmingly recommend the therapy that they themselves deliver.

Author Affiliations: Center for Survey Research, University of Massachusetts, Boston (Dr Fowler and Ms Elliott); Medical Practices Evaluation Center (Drs McNaughton Collins and Barry) and the Department of Radiation Oncology (Dr Zietman), Massachusetts General Hospital, Boston; and the Division of Urology, University of Connecticut Health Center, Farmington (Dr Albertsen).

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