Rates of referral to radiation oncology prior to RP

Referral to radiation oncology prior to prostatectomy: Referral rates in a New Zealand tertiary Centre (2022)

"Abstract
Background
Radical prostatectomy and radical radiotherapy have equivalent survival outcomes in the treatment of localised prostate cancer but differing side-effect profiles. The 2018 Faculty of Radiation Oncology of the Royal Australasian College of Radiologists (RANZCR) position statement recommends that patients have the opportunity to discuss all suitable treatment options, ideally with the relevant specialist.

This study aimed to determine the number and characteristics of men referred to radiation oncology before undergoing radical prostatectomy in the years immediately preceding the 2018 RANZCR position statement.

Methods
The electronic records of all men who underwent a radical prostatectomy in the Auckland region between 1 January 2016 and 31 December 2017 were retrospectively reviewed for documentation of a referral or offer of referral to radiation oncology, or multidisciplinary meeting (MDM) consensus for surgery before prostatectomy. Patient and tumour variables were collected.

Results
Between 1 January 2016 and 31 December 2017, 234 patients underwent radical prostatectomy for prostate cancer in the wider Auckland region. Before undergoing prostatectomy, 89 of 234 patients (38.0%) were referred, offered but declined referral, or had MDM consensus for surgery. Age and urologist were most strongly correlated with the primary outcome; those offered referral were older than those who were not (P = 0.030). The practice of one urologist was an outlier, referring or recommending referral to 92.3% of patients (P < 0.0001).

Conclusion
These results provide a benchmark for future studies assessing referral practices following the RANZCR position statement, and suggest a need for further education and advocacy regarding the role of radiotherapy in the treatment of localised prostate cancer."
________________________________________________

Discuss

(My uro/surgeon began the first of two visits of treatment discussion stating that RT and RP had equal oncological outcomes for my situation, that I and not he would have to be the one to make a decision, and that he had no problem referring me to a RO.)

Djin

My urologist stated that my scans indicated that the cancer was contained within the capsule and that surgery had a 50/50 likelihood of getting it all, but also mentioned that the need for salvage radiation was a possibility. He gave me a brochure with info on about a half dozen radiation therapies and the time frame and number of treatments required for each. A radiologist called me a few weeks later but I declined to schedule an appt as all this occurred just as we were emptying our house and relocating from Ohio to Florida.

If I had postponed the move any further so that I could go thru a couple months of treatment, my wife's lymphoma probably still would have been discovered around Christmas and I would have been driving her to chemo thru ice and snow. As its is, I drove our final u-Haul full of household goods to Florida and flew back to Ohio four days before my surgery. We slept in what had been our sons' beds while I recovered from RP and our house sold six weeks later.

That winter in Florida I drove five minutes to my daily ART under sunny skies.

At my diagnosis three different surgeons said no to surgery as they knew it would not be curative and I would need SRT. They all said to avoid that situation due to unnecessary increased probability of adverse treatment side effects.

They each said they would refer me to a surgeon if that is what I wanted. Interestingly they all mentioned the name of a very high volume surgeon that started robotic in our area. One of the more expressive said “this guy will operate on anyone, but he is excellent”.

I continue to be elated with the advice I got, the treatment method I used and especially the great results.

After two Uros failed to do anything after blood in my semen, a 3+3, a TURP and 3+4, the third Uro took over. The DX became a 4+4, one core 20% and pni. He went over his expertise in RALP. However, after he noted that I had 2 previous hernia surgeries and one gallbladder surgery, he laid out only one option. That was to do the RALP taking one nerve and some nodes. That I would need RA and ADT after. He noted that because of the previous surgeries he might have to switch during the operation to an open surgery with a big scar. My scans all noted contained PC.
My wife had just finished surgery and RA for breast cancer. At the same time I joined HW and started reading as many threads as I could. I had already told the Uro that I would proceed with the surgery. I started asking questions here and got great answers from all on both sides. My wife suggested I talk to her RA who was well versed in all cancer treatments having survived cancer himself. I went to him and he said either option would help, but added the chances with a GL 8 reoccurrence was there either way. He looked at my MRI and said that the TURP eliminated any seed placement that I read about here. He went over the SEs of both options and I cancelled the RALP. He started me on 18 months of ADT, did the SPACE OAR placement and then did 28 treatments of IMRT with a total of 70 gy.
I won’t look back. Age 69 at start of treatment and turn 70 in August. My best to all,
Jack

I believe the Australian social medicine would like to just allow RT for prostate cancer. Their cost matrix shows it expensive. New Zealand probably same deal.

Post Edited (Duck2) : 7/10/2022 9:39:04 AM (GMT-7)