Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study

Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the person’s perception of the quality of care they receive, at least among low-risk men. Therefore, the value of these second opinions remains unknown.

For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort.

Forty percent of the cohort said they had reached out for a second opinion, either because they wanted more information about their disease (50.8%) or wanted to be seen by the best doctor (46.3%). Second opinions, however, did not impact the final treatment decision or the perceived quality of cancer care. The authors found that men who were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio [OR], 0.49; 95% CI, 0.32-0.7). Men who were looking for additional information on their treatment were less likely to report satisfaction with their quality of cancer care (OR, 0.70; 95% CI, 0.49-0.99). The control cohort for this study was men who did not meet a urologist for a second opinion.

These study data can help inform oncologists and cancer organizations that encourage patients to seek a second opinion before treatment initiation, the objective being an improved understanding of their diagnosis and the ability to objectively weight the risks and benefits associated with their treatment. Especially among low-risk prostate cancer patients, second opinions could significantly impact decisions on treatment versus active surveillance. However, the study did not find an association between second opinions and treatment in low-risk men.

These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded.

Reference

Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment [published online November 7, 2016]. Cancer. doi: 10.1002/cncr.30412.