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Discord Among Radiation Oncologists and Urologists in the Postoperative Management of High-Risk Prostate Cancer

Kishan, Amar U., MD*; Duchesne, Gillian, MD; Wang, Pin-Chieh, PhD*; Rwigema, Jean-Claude M., MD*; Kishan, Arun U., MS*; Saigal, Christopher, MD; Rettig, Matthew, MD§,∥; Steinberg, Michael L., MD*; King, Christopher R., MD, PhD*

American Journal of Clinical Oncology: August 2018 - Volume 41 - Issue 8 - p 739–746
doi: 10.1097/COC.0000000000000381
Original Articles: Genitourinary

Objective: To query specialty-specific differences regarding postoperative radiotherapy (RT) for high-risk prostate cancer.

Materials and Methods: Electronic mail survey of radiation oncologists (ROs) and urologists. We sought to maximize absolute response number to capture contemporary practice ethos. The outcome of interest was association between response and specialty. Training level/expertise, practice setting, percentage of consultation caseload consisting of high-risk prostate cancer, and nationality were set as effect modifiers for multivariate logistic regression.

Results: In total, 846 ROs and 407 urologists responded. ROs were more likely to prefer adjuvant radiotherapy (ART). ART or early salvage radiotherapy (SRT, with early SRT defined as that delivered at prostate-specific antigen<0.2), whereas urologists were more likely to prefer early or delayed SRT (P<0.0001). ROs were more likely to prefer lower PSA thresholds for initiating SRT (P<0.0001), and more likely to recommend ART in the setting of adverse pathologic features or node-positive disease (P<0.0001). Significantly more ROs would recommend concurrent androgen deprivation therapy or pelvic nodal RT in the setting of node-positive or Gleason score 8 to 10 disease (P<0.0001).

Conclusions: Specialty-specific differences were readily elucidated with respect to timing and indications for ART and SRT, as well as for indications for androgen deprivation therapy and nodal RT. These differences are likely to create a sense of dissonance for patients, which may in turn explain the underutilization of postoperative RT in general practice.

Departments of *Radiation Oncology

Urology

§Internal Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles

Division of Hematology-Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, CA

Sir Peter MacCallum Department of Oncology, the University of Melbourne, Vic., Australia

The authors declare no conflicts of interest.

Reprints: Amar U. Kishan, MD, Department of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza Suite B265, Los Angeles, CA 90095. E-mail: aukishan@mednet.ucla.edu.

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