Sydney Herald

Prostate cancer patients confused in urology versus radiation oncology wars
February 8, 2016


[This article originally posted by the Sydney Herald has been reposted here by Dean Dubinsky.  To see the full article, click on the link at the end of the article.]

Men who have been diagnosed with prostate cancer face a confusing array of treatment choices, each with its own price tag and idiosyncratic side effects.

But when it comes to comparing the effectiveness of those treatments, things get political.

An international study that measured the long term survival rates from different prostate cancer treatments has needled the rivalries between the medical specialties that deal with the condition.

The biannual literature review by the Prostate Cancer Treatment Research Centre rated a type of radiation therapy known as brachytherapy as the most effective of six treatment options for men with a low or intermediate risk.

About 20,000 men are diagnosed with prostate cancer in Australia each year.

Radiation oncologists and urologists have tussled for years over the merits of their respective approaches, but urologists have traditionally had the advantage because they see the patients first when they come in for biopsies.

Radiation oncologist Sandra Turner said urologists were acting as gatekeepers to the treatment process, but failing to provide information about the alternatives to surgery. She said the specialities were polarised in the field of prostate cancer partly because 75 to 80 per cent of operations were done in the private sector where most consultants did not work closely with peers from other disciplines.

Unlike breast cancer, for example, when surgeons were involved in a woman’s treatment regardless of whether she had her breast removed, if a man opted to have radiation therapy he was lost business to the surgeon.

“And it’s not all about money but the bottom line is, there’s a massive financial incentive for surgeons to do an operation and they may not even be conscious of it,” said Associate Professor Turner, who is on the council of the faculty of radiation oncologists in the Royal Australian and New Zealand College of Radiologists.

“If you know that the core of your business is prostatectomies and you even lose 20 to 30 per cent of those guys who never have an operation, that’s a massive chunk of your income.”

Australasian Brachytherapy Group former chair Joseph Bucci said the results of the latest study might help boost the reputation of brachytherapy, which involves the permanent implantation of radiation seeds directly into the prostate gland.

The technique has gone out of fashion as techniques such as robotic surgery have surged in popularity. “The results look very good,” said Dr Bucci, a radiation oncologist.

“The patient is more empowered than in the past and this sort of information on the internet helps them to decide whether one treatment is better than another.”

The suggestion that radiation trumps surgery for effectiveness comes on the back of another report that found patients were struggling to pay for prostate cancer treatment, prompting the urology society to smack down some of its members for charging exorbitant fees.

It found most men who had been recently diagnosed spent up to $17,000 on treatment, but the amount ranged from $250 to more than $30,000.

One in 10 respondents to the survey, which was published in the European Journal of Cancer Care in November, decided not to pursue treatment and many reported that they had sold assets or increased their credit card limit to pay for it.

Urological society president Mark Frydenberg said his group was drafting a new position paper on out-of-pocket costs for its members.

“I can’t legally control what surgeons charge … but I can talk about the morals of our society and part of our job is to look after patients.”

There were also wide variances in the amounts charged by radiation oncologists, he said.

But he said the credibility of the study that compared treatment outcomes was dubious as it was not peer-reviewed and the authors were skewed to the radiation community.

Another recent study showed a higher rate of mortality for prostate cancer patients treated with radiotherapy as opposed to surgery.

And he rejected the charge that urologists were not providing information about radiation therapy, saying patients could access objective advice from the Cancer Council or independent resources given by their urologists.

“We strongly encourage men to seek these out and we advise people that they should get additional opinions,” Professor Frydenberg said.

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