Medical Oncology Consultation and Minimization of Overtreatment in Men With Low-Risk Prostate Cancer

• Copyright © 2014 by American Society of Clinical Oncology

Medical Oncology Consultation and Minimization of Overtreatment in Men With Low-Risk Prostate Cancer

1. Ayal A. Aizer, MD, MHS⇑, 
2. Jonathan J. Paly, 
3. M. Dror Michaelson, MD, PhD,
4. Sandhya K. Rao, MD, 
5. Paul L. Nguyen, MD, 
6. Irving D. Kaplan, MD,
7. Andrzej Niemierko, PhD, 
8. Aria F. Olumi, MD and 
9. Jason A. Efstathiou, MD, DPhil

+Author Affiliations

1. Harvard Radiation Oncology Program; Massachusetts General Hospital; Brigham and Women's Hospital-Dana-Farber Cancer Institute; and Beth Israel Deaconess Medical Center, Boston, MA

1. Corresponding author (and address for reprints): Ayal A. Aizer, MD, MHS,Massachusetts General Hospital, Department of Radiation Oncology, 100 Blossom St, Cox 3, Boston, MA 02114; e-mail: Aaaizer@partners.org.

Abstract

Purpose: Specialist bias, in which specialists recommend the therapy that they are capable of delivering, is thought to influence the treatment of patients with localized prostate cancer and to contribute to overtreatment of men with limited life expectancy. Consequently, rates of active surveillance, the preferred management modality per the National Comprehensive Cancer Network (NCCN) for patients with low- and very low-risk disease and a life expectancy of less than 10 and less than 20 years, respectively, are low. We sought to determine whether consultation with a medical oncologist is associated with increased rates of active surveillance in men with low-risk prostate cancer.

Methods: We identified 188 patients with low-risk prostate cancer undergoing active surveillance at one of three referral centers in Boston, MA in 2009. Multivariable logistic regression was used to determine whether consultation with a medical oncologist was associated with selection of active surveillance. The data were reanalyzed for patients with low- and very low-risk disease and a life expectancy of less than 10 and less than 20 years, respectively.

Results: Consultation with a medical oncologist was associated with increased rates of active surveillance (37% v 21%, P = .01), an association that remained significant on multivariable logistic regression (odds ratio [OR] = 2.70; 95% CI, 1.27 to 5.75; P = .01). When applied to patients with limited life expectancy, this finding remained significant (OR = 4.74; 95% CI, 1.17 to 19.25; P = .03).

Conclusion: Consultation with a medical oncologist is associated with increased rates of active surveillance, adherence to NCCN guidelines, and minimization of overtreatment in men with early prostate cancer and limited life expectancy.