Are Urologists and/or Radiation Oncologists Biased when Reporting of Advantages and Disadvantages of Surgery versus Radiation in Consultations for Early-Stage Prostate Cancer?

BACKGROUND

Treatment choice for early-stage prostate cancer (PC) is strongly influenced by the counseling physician's specialty. Whether a physician's specialty biases how treatment advantages and disadvantages are presented in consultations is unclear. To investigate this, we analyzed content discussed by urologists and radiation oncologists when comparing radical prostatectomy and radiation therapy in PC consultations.

METHODS

Consultations of 39 men with nonmetastatic PC across 6 urologists and radiation oncologists were recorded and transcribed. Analysts thematically characterized statements comparing advantages and disadvantages of surgery versus radiation (and vice versa) using an open coding approach. Frequency of thematic content by specialty was reported at a consultation level. Themes exceeding 10% and differing by ≥ 25% between specialties were reported.

RESULTS

Our dataset included 1171 statements from 28 Urology and 11 Radiation Oncology consults. Major themes discussed included side effects (90%), cancer control (84%), convenience (56%), salvage options (48%) and invasiveness (43%). Differences in content between specialties were observed for all themes except convenience. For side effects, radiation oncologists (vs. urologists) more often noted that radiation has better urinary (55% vs. 0%) and erectile side effects than surgery (37% vs. 0%). For salvage therapy, urologists more often mentioned inability to get radiation twice (32% vs. 0%) and difficulties with salvage prostatectomy (36% vs. 0%). For cancer control, urologists more often noted long-term data on surgery outcomes as an advantage of surgery (25% vs. 0%). For invasiveness, radiation oncologists more often described radiation as less invasive (36% vs. 11%).

CONCLUSIONS

While specialists acknowledge obvious limitations of their treatments, they selectively highlight advantages of their procedures and the disadvantages of competing treatments.