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Androgen deprivation therapy, an effective but costly and potentially toxic treatment, is often used to treat advanced prostate cancer.

But a new study suggests that a patient's choice of physician, rather than the stage of his cancer, may determine whether or not he gets the treatment.

Researchers at the University of Texas Medical Branch at Galveston studied the treatment histories of nearly 62,000 men from a Medicare database, age 65 and older, who were diagnosed with prostate cancer. They also looked at data on the patients' 1,802 urologists and the frequency with which they prescribed androgen deprivation therapy.

The therapy, which prevents production of cancer-promoting steroid androgens in cells, is used in approximately half of all prostate cancers, typically for more advanced or metastatic tumors.

According to the study, just 9.7 percent of patients prescribed the therapy received it because of the stage or grade of their tumors. Twenty-one percent seemed to have been prescribed androgen treatment because it was favored by the urologist they saw. In fact, use of the therapy could be attributed to symptoms and other patients' specifics only 4.3 percent of the time, the team said.

The findings "suggest that interventions at the level of the urologist may be an effective way to modify the use of this therapy for prostate cancer," the authors wrote in a prepared statement.

An editorial, written by Dr. Paul F. Schellhammer, of Eastern Virginia Medical School in Norfolk, appears alongside the findings, which appear in the June 21 issue of the Journal of the National Cancer Institute.

Schellhammer said, "the challenge for urologists is to offer men with high-risk, potentially lethal prostate cancer androgen deprivation therapy early in their course of treatment and to avoid the unnecessary risks of androgen deprivation therapy among men with low-risk indolent [slow-moving] disease."

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