San Luis Obispo leads the nation in prostate removal

March 1, 2011

By LISA RIZZO

San Luis Obispo County doctors are pushing radical prostatectomys at a rate nearly three times the national average, according to a recently released health report.

Researchers from the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making found that male Medicare patients over 65 with early-stage prostate cancer, who live in San Luis Obispo County, are 12 times more likely to have surgery to remove their prostate than those who live in Albany, Ga.

San Luis Obispo County had the highest prostatectomy rate in the country at 3.8 surgeries per 1,000 men over 65 enrolled in traditional Medicare during 2003 to 2007 compared to the national average of 1.4 procedures, according to the findings. The low was Albany, Ga. at 0.3 surgeries per 1,000 men in the same category.

The study released late last week examined the latest available Medicare data and observed wide variations in elective surgery rates, or “preference-sensitive” procedures, among Medicare patients with similar conditions across the country. And researchers found–location matters.

“These striking variations are the by-product of a doctor-centric medical delivery system. In highlighting the variation from community to community for elective procedures, we hope to shine a light on the fact that patients’ preferences are not always taken into account when medical decisions are made,” said Shannon Brownlee, M.S., lead report author and instructor at the Dartmouth Institute for Health Policy and Clinical Practice in a statement.

Researchers attribute the geographical variations in surgical rates to differences in clinicians’ personal beliefs and opinions, a lack of consensus in the medical community about the best treatment and ill-informed patients.

The organization is advocating for shared decision making, a change from the common mentality “the doctor knows best.”

“All too often, patients facing elective surgery are not given an opportunity to learn about the full range of options, and that each choice has unique risks and benefits,” said David C. Goodman, M.D., M.S., report co-author and co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.

“Many are not even aware that the decision about an elective procedure is actually a choice. Instead, they routinely delegate such important decisions to their clinicians, with the result being that patients often do not get the treatment they would prefer.”

When a treatment is elective, it means there is more than one option—each with different benefits and drawbacks. How a patient views those trade-offs differs from person to person.

The main options for addressing early-stage prostate cancer are active surveillance, surgery and radiation. Doctors receive more compensation for prostate removal surgery than radiation therapy and it requires a shorter period of patient care, according to the American Society of Clinical Oncology.

The report describes the treatment options in greater detail:

While active surveillance avoids the side effects of treatment, it involves regular biopsies and runs the risk that the cancer will progress and eventually cause symptoms or lead to death. Surgery may reduce the risk of dying of prostate cancer, but it has significant common side effects including incontinence and erectile dysfunction. Radiation also has side effects and it is unclear whether the risk of death is reduced.

“Surgery may reduce a man’s chances of dying from prostate cancer. But for many men, especially those with other health issues, the prostate cancer will never cause harm, even if left untreated,” the report explains. “If the cancer has spread beyond the prostate, removing it surgically may not offer a cure.”