Cancer societies encourage patients with cancer to obtain second
opinions prior to starting treatment to help them understand their
disease and to thoroughly weigh the risks and benefits of their options.
Given the ongoing debate concerning whether prostate cancer patients
are being overtreated, second opinions in this context are important
because management options vary widely from surgery and radiation
therapy to active surveillance programs.
A new analysis indicates that many men with prostate cancer obtain
second opinions from urologists before starting treatment, but
surprisingly, second opinions are not associated with changes in
treatment choice or improvements in perceived quality of prostate cancer
care. Published early online in CANCER
, a peer-reviewed
journal of the American Cancer Society, the findings also explore
motivations for seeking second opinions, and suggest that second
opinions may not reduce overtreatment in prostate cancer.
‘Second opinions are not associated with changes in treatment choice or improvements in perceived quality of prostate cancer care.’
However, the study did not find
that second opinions affected treatment among low-risk men - the most
likely candidates for active surveillance - casting doubt on whether
second opinions are sufficient to reduce overtreatment among this group.
Archana Radhakrishnan of Johns Hopkins University, in
Baltimore, and her colleagues sought to assess the frequency of and
reasons for second opinions for localized prostate cancer, and the
characteristics of those who seek them. They also evaluated whether
second opinions are associated with certain treatment choices or
perceived quality of prostate cancer care.
The investigators surveyed men as part of the Philadelphia Area
Prostate Cancer Access Study (P2 Access). A total of 2386 men who were
newly diagnosed with localized prostate cancer in the greater
Philadelphia area between 2012 and 2014 responded.
40% of men
obtained second opinions, commonly because they wanted more information
about their cancer (50.8%) and wanted to be seen by the best
doctor (46.3%). Overall, obtaining second opinions was not linked
with receiving definitive treatment or with perceived quality of cancer
Men who sought second opinions because they were dissatisfied with
their initial urologist were 51% less likely to receive
definitive treatment, and men who wanted more information about
treatment were 30% less likely to report excellent quality of
cancer care compared with men who did not receive a second opinion.
who obtained second opinions because they wanted more information, were
seeking the best doctor, or had been encouraged to by family or friends
were more likely to ultimately receive surgery. The authors suggest this
could indicate that for some men, second opinions represent a way to
pursue the treatment they already plan on receiving, rather than to
explore other treatment options
"Patients often report getting second opinions for prostate cancer.
Their impact on care that patients receive remains uncertain," said Dr.