Referral to radiation oncology prior to prostatectomy: Referral rates in a New Zealand tertiary Centre

Background: Radical prostatectomy and radical radiotherapy have equivalent survival outcomes in the treatment of localised prostate cancer but differing side-effect profiles. The 2018 Faculty of Radiation Oncology of the Royal Australasian College of Radiologists (RANZCR) position statement recommends that patients have the opportunity to discuss all suitable treatment options, ideally with the relevant specialist. This study aimed to determine the number and characteristics of men referred to radiation oncology before undergoing radical prostatectomy in the years immediately preceding the 2018 RANZCR position statement.

Methods: The electronic records of all men who underwent a radical prostatectomy in the Auckland region between 1 January 2016 and 31 December 2017 were retrospectively reviewed for documentation of a referral or offer of referral to radiation oncology, or multidisciplinary meeting (MDM) consensus for surgery before prostatectomy. Patient and tumour variables were collected.

Results: Between 1 January 2016 and 31 December 2017, 234 patients underwent radical prostatectomy for prostate cancer in the wider Auckland region. Before undergoing prostatectomy, 89 of 234 patients (38.0%) were referred, offered but declined referral, or had MDM consensus for surgery. Age and urologist were most strongly correlated with the primary outcome; those offered referral were older than those who were not (P = 0.030). The practice of one urologist was an outlier, referring or recommending referral to 92.3% of patients (P < 0.0001).

Conclusion: These results provide a benchmark for future studies assessing referral practices following the RANZCR position statement, and suggest a need for further education and advocacy regarding the role of radiotherapy in the treatment of localised prostate cancer.