An analysis found that many men newly diagnosed with prostate cancer in the U.S. seek second opinions before starting treatment, but that extra effort rarely led to changes in treatment approaches, perceptions of the care given, or the likelihood of overtreatment in low-risk patients.
The study, published online in Cancer, an American Cancer Society (ACS) scientific journal, was titled “Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment.”
Archana Radhakrishnan, MD, MHS, of Johns Hopkins University, lead a research team in evaluating how frequently, and why, patients sought second opinions for localized prostate cancer, and in assessing whether second opinions had any relation to treatment choices or perceived care.
The team surveyed 2,386 men in the greater Philadelphia area diagnosed with localized prostate cancer between 2012 and 2014. All were part of the Philadelphia Area Prostate Cancer Access Study (P2 Access).
About 40 percent sought second opinions, mostly, they said, because they needed to feel more informed about their cancer and options (50.8%), and because they wanted the best doctor possible (46.3%). Overall, second opinions were not found to be associated with choosing a definitive treatment (one aiming at a cure) or views of care quality.
With an ongoing debate regarding prostate cancer overtreatment, second opinions are thought to be important because prostate cancer treatment options can vary from surgery and radiation to active surveillance. But the study found that second opinions do not affect treatment choices among low-risk patients, those most likely to benefit from active surveillance, casting doubt on whether such opinions would reduce overtreatment in this group.
The study also found that most men who obtained second opinions because they were unhappy with their initial urologist were 51 percent less likely to receive definitive treatment. And those wanting to learn more were 30 percent less likely to report “excellent” quality of care compared to men who did not seek a second opinion.
Second opinions, the researchers said, represent more of a way of pursuing an original treatment plan with added support, than exploring treatment options.
“Patients often report getting second opinions for prostate cancer. Their impact on care that patients receive remains uncertain,” Radhakrishnan said in a press release.