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Second opinions for prostate cancer may not lead to treatment change

by Thomas Dworetzky, Contributing Reporter | November 18, 2016
Rad Oncology
That second opinion for prostate cancer may not lead to treatment change, a new study has found.

“Patients often report getting second opinions for prostate cancer. Their impact on care that patients receive remains uncertain," said Dr. Archana Radhakrishnan, one of the researchers, in a statement.

The findings by Radhakrishnan of Johns Hopkins University, in Baltimore, and colleagues were published early online in CANCER, the peer-reviewed journal of the American Cancer Society.

The report also sought to uncover the motivations behind the search for second opinions by patients.

In the face of ongoing questions about whether or not certain treatments are worthwhile for certain prostate cancer diagnoses, the study found that “although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care.”

In fact, for low-risk men, the researchers found that additional opinions did not impact treatment choices.

At present cancer organizations do encourage the use of second opinions before treatment, so that patients understand the disease before rushing into treatment, “because management options vary widely from surgery and radiation therapy to active surveillance programs,” according to the study.

A total of 2365 men with localized prostate cancer in the greater Philadelphia area from 2012 to 2014 were studied.

Second opinions were sought by 40 percent. Of these, 50.8 percent said that they were seeking more information about their cancer. Another 46.3 percent got an additional opinion because they were looking to be seen by the “best doctor.”

“Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care,” stated the researchers, noting, “Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment, and men who wanted more information about treatment were less likely to report excellent quality of cancer care compared with men who did not receive a second opinion.”

The issue of active surveillance was in the news in September when research emerged indicating that active monitoring is as effective as aggressive treatment for early-localized prostate cancer patients.

A randomized study followed men who had been diagnosed with the disease and found that “at a median of 10 years, prostate cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments,” said lead author Dr. Freddie C. Hamdy and fellow researchers in their JAMA report on the National Institute for Health Research–supported Prostate Testing for Cancer and Treatment (ProtecT) trial in the U.K.

Death rates hovered near just one percent for all.

“There’s been no hard evidence that treating early disease makes a difference,” Hamdy, of the University of Oxford, stated at that time.

The findings are striking. “Virtually no one had died from prostate cancer,” Dr. Mark Litwin, chair of urology at the David Geffen School of Medicine at UCLA. Litwin was not part of the research. “All three groups have almost 100 percent surviving. That should give all men pause before pursuing radical treatment for low- or intermediate-risk tumors.”

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