Urologists in solo practice more likely to overuse gonadotropin agonists

NEW YORK - Urologists in solo practice and those not affiliated with a medical school are more likely to overuse gonadotropin-releasing hormone agonists (GnRH) to treat prostate cancer, new findings show.

Non-Hispanic blacks, Hispanics, and men of "other" race are also more likely to receive unnecessary GnRH agonists, Dr. Shellie Ellis, of the University of Kansas School of Medicine in Kansas City, and her colleagues found.

"The overall news is good," Dr. Ellis told Reuters Health in a telephone interview. "We continue to see hormone therapy for low-risk, localized prostate cancer is declining." Nevertheless, she added, overuse does persist among some physicians and for some patients.

GnRH agonists are the first-line treatment for men with metastatic prostate cancer, and may also be used as an adjunct to radiation therapy in some men with localized disease, Dr. Ellis and her team note in their report, online April 7 in Prostate Cancer and Prostatic Diseases.

GnRH agonist use in men with localized disease became increasingly common starting in the 1990s, reaching a peak in 2003, when the Medicaid Modernization Act passed. The act provided for incremental decrease in reimbursement for GnRH agonists by 65%.

While GnRH overuse had fallen by 34% by 2005, Dr. Ellis and her colleagues add, 25.7% of men for whom the treatment was not recommended still received GnRH agonist treatment.

Dr. Ellis and her colleagues matched physician data from the American Medical Association for 2,138 urologists to Surveillance, Epidemiology, and End Result-Medicare data for 12,943 men diagnosed with early stage, lower-grade prostate cancer in 2000-2007.

They found no link between length of time a urologist had been in practice and overuse. However, doctors in solo practice were 65% more likely to overuse GnRH agonists, while those affiliated with a medical school were 35% less likely to do so. Black men were 76% more likely than whites to be over-treated with GnRH agonists, while Hispanics were at 41% increased risk of overtreatment. The risk was 44% higher for men of "other" races compared with whites.

It's possible, Dr. Ellis said, that solo practitioners may have a different panel of patients than group practitioners. "It also may be that those solo practitioners don't have access to referral networks that might help them find other options for their patients," she added. "Some of these patients seem to have some other risk factors so perhaps they were not candidates for surgery, but it's not clear why some of the other options may not have been used."

While active surveillance is recommended for many patients with prostate cancer, Dr. Ellis said, it remains underused.

She and her colleagues are currently recruiting urologists in community practice for a study investigating why active surveillance is not used more frequently. She and her colleagues will also be at the American Urological Association's annual meeting in May to recruit urologists for the study.

This research was supported by the National Cancer Institute, American Cancer Society, the Urology Care Foundation/Astellas, and the U.S. Department of Veterans Affairs. The authors declared no conflicts of interest.

SOURCE: http://bit.ly/1DcaMV3

Prostate Cancer Prostatic Dis 2015.

References: Reuters Health
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