Effect of urologists and medical oncologists on treatment of elderly men with Stage IV prostate cancer

Objectives: To examine, among elderly men with incident advanced prostate cancer (PCa), their treatment, in general, and chemotherapy, in particular, in association with a posturologist medical oncologist/hematologist (PUMOH) visit. The role of specialists in the management of advanced PCa is evolving in response to positive chemotherapy trials of PCa.

Methods: Linked Surveillance, Epidemiology, and End results and Medicare data included patients with Stage IV PCa diagnosed from 1994 to 2002 who had visited a urologist after the diagnosis and received treatment. The visits and treatment were examined, comparing patients with and without PUMOH visits.

Results: Most (77%) patients received treatment of their PCa and 85% of treated patients had a subsequent visit with a urologist, of whom 91% saw the urologist first (n = 5435). Of these, 43% saw only the urologist, 41% saw a medical oncologist/hematologist, and 32% saw a radiation oncologist. Of the 5435 patients, 16% received chemotherapy and the adjusted odds of chemotherapy receipt were 7.2 times greater (95% confidence interval 6.0-8.7, P < .001) among those with a PUMOH visit. Compared with non-Hispanic whites, black Americans were less likely (adjusted odds ratio 0.53, P < .001) to receive chemotherapy, although the likelihood of a PUMOH visit was similar (adjusted odds ratio 0.86, P = .14) among the groups.

Conclusions: The results of our study have shown that nearly one quarter of men with Stage IV PCa receive no PCa treatment. Although a PUMOH visit is a significant predictor of chemotherapy receipt, many men with advanced PCa received chemotherapy without a medical oncologist/hematologist visit. Black American and elderly men were less likely to receive chemotherapy for advanced PCa.