Men diagnosed with prostate cancer often seek second opinions

Most men with localized prostate cancer sought second opinions to gain more information or to be seen by the best urologist, but not to find different treatment or improved quality of care, according to results of a survey published in Cancer.

“In accordance with recommendations from national cancer organizations, our results suggest that a substantial proportion of men with prostate cancer (40.2%) obtain an opinion from a second urologist regarding their treatment,” Archana Radhakrishnan, MD, MHS, general internal medicine fellow at Johns Hopkins University, and colleagues wrote. “The high rate of second opinions underscores their potential importance in cancer care delivery.”

With an estimated 180,890 men diagnosed with the disease in 2016, prostate cancer is rated by the CDC as the most common cancer among men. Treatment options localized prostate cancer vary from surgery and radiation therapy to active surveillance programs, with differing benefits and costs.

Thus, second opinions are crucial for these men to gain more information about potential management plans and better understand their disease.

Radhakrishnan and colleagues assessed the frequency of and reasons for seeking second opinions among men with localized prostate cancer.

Researchers surveyed 2,365 men (mean age, 65.4 years) with localized prostate cancer from the greater Philadelphia area from 2012 to 2014. Most respondents were white (78.5%), had some college education or higher (62.2%) and were privately insured (55.3%). Further, most men had low-risk tumors with Gleason scores less than 7 (79.6%) and clinical tumor stage I disease (71.4%).

Overall, 40.2% of the men obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%).

Another 25% noted they wanted to find out about treatment not offered by their initial doctor.

Dissatisfaction with their first urologist was the least frequently reported reason to seek a second opinion (15.5%).

Compared with patients aged younger than 70 years, men aged 70 to 74 years (OR = 0.47; 95% CI, 0.32-0.72) and men aged older than 75 years (OR = 0.3; 95% CI, 0.19-0.47) were less likely to seek second opinions.

Of those who received a second opinion, 76.5% received definitive treatment — defined as radical prostatectomy or radiation therapy — compared with 81.6% of men who did not receive a second opinion. Researchers reported that obtaining a second opinion was not associated with definitive treatment (OR = 0.95; 95% CI, 0.84, 1.08).

Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment than men who did not receive a second opinion. (OR = 0.49; 95% CI, 0.32-0.73).

Additionally, men who sought second opinions to acquire more information about treatment were less likely to report excellent quality of care (OR = 0.7; 95% CI, 0.49-0.99) than those who did not obtain second opinions.

Radhakrishnan and colleagues noted that self-reported surveys may be subject to recall bias and that they lacked information on the content of physician–patient discussions during second opinion visits.

“Additional research is needed to better understand the content of these second opinion visits in order to assess their value in cancer care,” Radhakrishnan and colleagues wrote. – by Chuck Gormley

Disclosure: Radhakrishnan reports financial support from the National Heart, Lung, and Blood Institute. Please see the full study for a list of all other researchers’ financial disclosures.