Men need more info on prostate cancer options

When it comes to treating localized prostate cancer, treatment decisions frequently do not appear to reflect patient preferences, investigators report in an upcoming issue of Cancer.

“I think fear is a big factor, and I don’t think patients have the information to discriminate between what it means to have prostate cancer versus what it means to have other types of cancer that are more aggressive,” Dr. Steven B. Zeliadt told Reuters Health.

There is no “gold standard” for the best treatment of localized prostate cancer. The treatment choices include surgery (radical prostatectomy), X-ray therapy, implantation of radioactive pellets (brachytherapy) and “watchful waiting,” the authors of the study note. Despite a plethora of studies examining how men decide on a treatment plan when they are diagnosed with localized prostate cancer, there is no consensus on what issues actually guide their decisions.

Zeliadt, from the Fred Hutchinson Cancer Center in Seattle, and his associates identified 69 studies concerning the treatment decision-making process for localized prostate cancer. The findings will appear in the May 1st issue of Cancer.

Cancer eradication is the primary concern of most patients. The advice men are given varies according to physician specialty and usually does not include all pertinent information required to make an informed decision about survival and quality of life, the researchers report. And the information does not always take into account the seriousness of the patient’s cancer.

“Currently, patients don’t have the tools needed to integrate and synthesize the pros and cons of treatment,” Zeliadt said. “Discussions that physicians have with their patients are generally not geared towards that integration; instead physicians tend to emphasize the benefits” of the treatment they are most familiar with.

Nevertheless, physician recommendation is a major influencing factor for more than half of patients interviewed. Study results suggest that physicians’ advice varies, with blacks and men with lower income or education levels receiving less aggressive treatment.

“It’s important for men to know that there’s not really a bad decision to be made when considering treatment for localized prostate cancer—that all treatments are pretty favorable,” Zeliadt noted. “Patients tend to worry about which one is better in terms of survival, but that might not be the place to focus their energy. Instead, they should consider the side effects with each treatment option and how they will impact their lives.”

Zeliadt and his associates recommend more studies to examine how the patient’s priorities evolve from diagnosis to treatment completion. They also suggest that researchers explore how patients’ personal values affect their decisions, as well as the role of family members, patients’ ethnicity and socioeconomic status, and the settings in which men receive treatment.

SOURCE: Cancer May 1, 2006.

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