FOR INFORMATION CONTACT:
Dr. Timothy J. Wilt
(612) 725-2158
Sharon Skoblik
(612) 725-2102
Embargoed by the Journal of the American Medical Association
For Release on Tuesday, June 27, 2000 at 3:00 PM, CT
UNCERTAINTY IN PROSTATE CANCER CARE
Treatment Options Offered Not Always in the Patient's Best Interest
MINNEAPOLIS -- The 180,000 men diagnosed annually with prostate cancer in the U.S. do not have the necessary information needed to make important treatment decisions, according to an editorial in the June 28 issue of the Journal of the American Medical Association (JAMA).
In his editorial, Timothy Wilt, M.D., MPH, of the Minneapolis Veterans Affairs (VA) Center for Chronic Disease Outcomes Research, says urologists and radiation oncologists commonly recommend the treatments that they personally provide, rather than accurately providing information to patients about the risk involved, and the lack of scientific evidence to support the effectiveness or preference of a particular treatment option.
"Specialists mean well when they make treatment recommendations. Unfortunately, these intentions are frequently not supported by convincing evidence and may not be in the best interest of the patient," says Wilt.
Doctors often have insufficient office time to clearly explain treatment options and underestimate the patient's desire for and ability to cope with information. The net result is what Wilt calls "salesmanship of medicine," in which specialists recommend their own treatment services rather than working with patients to provide a balanced presentation of the known risks and unproven benefits of all available options.
One factor leading to this practice is the current dearth of high quality research findings for localized prostate cancer. There have been no adequately designed randomized controlled trials (RCTs) completed in the field and all current treatment decision aids rely on data from uncontrolled studies.
As scientists work to close the gap in treatment information, Wilt suggests that physicians encourage their prostate cancer patients to enroll in RCTs. Current treatment options are based solely on physician recommendations, patient testimonials, and news media reports relying on anecdotal comments and evidence from methodologically flawed studies.
RCTs offer a chance for men diagnosed with prostate cancer to receive scientifically sound treatment while helping to further research on the disease. For patients wanting to learn more about enrollment in RCTs, Wilt recommends two websites: http://clinicaltrials.gov or http://cancernet.nci.nih.gov.
One current trial, underway at VA and the National Cancer Institute, is the Prostate Cancer Intervention Versus Observation Trial (PIVOT). PIVOT will determine whether radical prostatectomy or watchful waiting provides superior length and quality of life in men with localized prostate cancer.
Wilt believes that until more substantial evidence is gathered on the efficacy of today's prostate cancer treatments, most patients are left with uncertainty about their treatment decisions. "All we have right now is unsubstantiated evidence," says Wilt. "Until we learn more about current options, the process of deciding which treatment method to use is similar to flipping a coin."
- 30 -
SPECIAL NOTE FOR REPORTERS: Dr. Timothy J Wilt of the Minneapolis VA Medical Center is available for press interviews to discuss the JAMA prostate cancer care editorial. He can be reached at (612) 725-2158. For additional assistance, please contact Sharon Skoblik at (612) 725-2102 or Jim Blue at (212) 807-3429.
RSS