AUA 2018: Effect of Selection and Referral Biases for the Treatment of Localized Prostate Cancer with Surgery or Radiation

San Francisco, CA (UroToday.com) Multidisciplinary consultation has been widely advocated in many oncologic tumor sites. This is notably true for patients with localized prostate cancer for whom a number of viable treatment options, surgery, radiotherapy, and surveillance, exist. While it may be expected that multidisciplinary consultation involving both radiation oncologists and urologists would change the distribution of active treatment choices compared to consultation with a urologist alone, the effect of surveillance rates is unclear. In a podium presentation at the American Urologic Association Annual Meeting presented by Dr. Nam on behalf of his colleagues, population-based data from Ontario, Canada were used to assess this question. 



The authors identified all patients newly diagnosed with non-metastatic prostate cancer in Ontario, Canada from 2010 to 2013. Patients who received consultation with a radiation oncologist as well as a urologist within 90 days of diagnosis were matched 1:1 with patients who saw a urologist alone. Matching included patient demographics including detailed comorbidity data, tumor factors (grade, stage, PSA), and health care utilization data. The primary outcome was receipt of active treatment. 

Among 16,666 eligible patients, matched pairs could be created for 11,416. After matching, patients with intermediate or high risk prostate cancer who saw a radiation oncologist were significantly more likely to undergo active treatment. Similarly, for patients with low-risk disease, those who saw a radiation oncologist were much more likely to receive active treatment and much less likely to undergo surveillance. In subgroup analyses limited to patients with very low risk disease, the elderly, and the comorbid, this finding persisted. 

The authors conclude that patients who undergo consultation with radiation oncologists prior to prostate cancer treatment are more likely to receive active therapy, regardless of patient demographic, comorbidities and tumor characteristics. As multidisciplinary consultation is increasingly adopted, an awareness of the biases underlying these differences should be considered. 

Presented By: Robert Nam 
Co-authors: Christopher Wallis, Gerard Morton, Sender Herschorn, Ronald Kodama, Girish Kulkarni, Sree Apuu, Bobby Shayegan, Roger Buckley, Arthur Grabowski, Steven Narod,  

Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJDat the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA