Urologists reject Radiation Oncologists’ position on prostate cancer

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The Urological Society of Australia and New Zealand (USANZ) notes with interest the position statement released by the Royal Australian and New Zealand College of Radiologists (RANZCR) about Informed Decision Making in the Management of Localised Prostate Cancer.

USANZ strongly agrees with the statements that men must be supported to make informed decisions about management and treatment and must have the opportunity to discuss all available treatment options in detail before making a decision.

"USANZ, however, must respectfully disagree with the RANZCR position statement that all men must see both a urologist (urological surgeon) and radiation oncologist to be fully informed as there is no evidence to support that this recommendation is best practice," says USANZ President, Adjunct Professor Peter Heathcote.

"Urologists are highly trained and experienced to counsel men and their families in the management of prostate diseases. We acknowledge that there may be a minority of men who may have been inadequately informed about all their treatment options, but the majority do feel fully informed after a thorough consultation with their treating urologist. Those men who feel that they have not received sufficient information or require further clarification are recommended where possible to seek additional opinions from other urologists, radiation and/or medical oncologists. As such USANZ believes that while some men need to be supported and encouraged, this is not necessary for all men as suggested by the RANZCR document.

"Whilst delays in treatment decision rarely lead to any patient harm, additional opinions are potentially costly to the health system and the patient, may lead to patient inconvenience especially in regional and rural areas, and may be unwanted by the patient if they do feel adequate information has been provided to them at their initial and subsequent consultations.

"It is critical that urologists discuss radiation options, not only because radiation therapy can be a valid and appropriate alternative to surgery, but because urologists also play a critical role in the delivery of some forms of radiation therapy (brachytherapy); in the management of side effects from radiation therapy; and may be required to perform salvage surgery if radiation treatment is unsuccessful. As such urologists have a strong role in counselling men about the risks and benefits of both surgery and radiation therapy, not just surgery," says Adjunct Professor Heathcote.

It is the opinion of USANZ that best practice is thorough personal counselling, presentation of cases in multi-disciplinary team meetings, and the provision of robust written information to patients and their families as the best way of providing information and advice to patients.

"Naturally if a patient feels that they have not received adequate advice from their urologist they should be encouraged to ask questions until those questions are adequately answered. In those circumstances, where all options of treatment have not been discussed or inadequately discussed, USANZ would support and
encourage men to obtain second opinions from other urologists, radiation or medical oncologists so that they are fully informed before making their decision. If, however, patients feel that they have received a thorough explanation of all treatment options by their treating urologist, and do not want nor require further counselling prior to making an informed decision, then additional consultations may not be necessary and would not constitute best practice.

"Whilst USANZ disagrees with RANZCR regarding the wording in this position statement, both organisations are striving to ensure that best quality information and care is delivered to the community. This is not a discussion about which treatment is better - both have risks and benefits that need thorough discussion with patients. This is simply a discussion about how best that information can be delivered to the public. USANZ wants to reassure all men and their families that urologists, radiation and medical oncologists collaborate very well and effectively in cancer teams across both Australia and New Zealand to ensure the best possible clinical outcomes for all our patients," says Adjunct Professor Heathcote.

The Royal Australasian College of Surgeons (RACS) supports the position taken by the Urological Society of Australia and New Zealand with regard to Informed Decision Making in the Management of Localised Prostate Cancer.

"As advocates for surgical standards, professionalism and surgical education in Australia and New Zealand, RACS and its surgical specialties share the mutual goal of providing the highest quality care possible to the communities we serve. Urologists like other surgeons are trained to ensure that full informed consent regarding the management of the condition including surgery and the likely outcomes form the moral, ethical and professional basis of the doctor-patient relationship. We encourage patients to discuss their treatment options with their surgeons," says RACS president John Batten.

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