Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions

World J Urol. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. Epub 2010 Oct 20.


Objectives: This study describes urologist recommendations for treatment among local-stage prostate cancer patients presenting for initial management consultations versus second opinions. We hypothesized that urologists present a wider range of management recommendations and are less likely to consider the patient preference during the initial consultation.

Methods: Newly diagnosed local-stage prostate cancer patients and their urologists participated in a survey at urology practices in three states. The urologist's survey included questions about the patient's clinical status, treatments discussed and recommended, and factors that influenced the urologist's recommendations.

Results: Of the 238 eligible patients, 95 men presented for an initial consultation, and 143 men presented for a second opinion. In multivariate analysis, urologists recommended 0.52 more treatments (standard error 0.19, P<0.001) during an initial consultation as opposed to a second opinion. The proportion recommending surgery increased from 71-91% (initial consultation versus second opinion setting). Among initial consultations, 59% had low-risk disease, and urologists' recommendations included surgery (80%), external radiation (38%), brachytherapy (seeds) (52%), and active surveillance (25%). Of the 54% with low-risk disease in a second opinion consultation, urologists' recommendations included surgery (90%), external radiation (16%), brachytherapy (14%), and active surveillance (16%).

Conclusions: In second opinion settings urologists discussed fewer treatment options and recommended surgery more often. These findings also applied to men with low-risk prostate cancer.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Brachytherapy
  • Data Collection
  • Drug Therapy
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Patient Preference*
  • Practice Patterns, Physicians'
  • Prospective Studies
  • Prostatectomy
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy*
  • Referral and Consultation / trends*
  • Specialization*
  • Urology*
  • Watchful Waiting