“Prostate cancer is the most common male cancer in Western Europe,
but this study shows that men facing treatment have a poor
understanding of how their treatment decision will affect their
lives,” Marie-Anne Van Stam of the University Medical Center Utrecht
in the Netherlands told Reuters Health in an email interview.
“This means that they are often not able to understand the
differences in outcomes and side effects among the different
treatment options, and end up making decisions on instinct.”
Options for treating prostate cancer that hasn’t spread include
removal of the prostate gland, radiation therapy and active
surveillance, in which doctors monitor the cancer but don’t treat it
unless it grows.
While radical prostatectomy is the most invasive approach, it does
not reduce the risk of disease recurrence compared to radiation
therapy. Patients who undergo surgical treatment face a higher risk
of urinary incontinence and erectile dysfunction, while radiation
treatment is associated with bowel and urinary problems, the
researchers note in the journal BJU International.
Van Stam and her team analyzed questionnaires completed by 474
prostate cancer patients who had just received information about
their treatment options from a urologist.
Just over one-third of the patients were aware that cancer
recurrence was just as likely with surgery as with radiation, while
39 percent were aware that prostatectomy increased the risk of
incontinence. Twenty percent knew that 10-year mortality is similar
with active surveillance, radiation and surgery.
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Forty-five percent of the survey respondents thought that patients
on active surveillance always wound up receiving radiation or
therapy later on. In fact, according to Van Stam, only half of
patients on active surveillance require definitive treatment.
Patients who spoke to a nurse specialist or radiotherapist in
addition to the urologist had a better understanding of the
differences between treatments. “This finding encourages the
incorporation of a nurse specialist and/or multidisciplinary
consults in routine care,” Van Stam said.
“We don’t expect patients to become experts in prostate cancer, this
is a once in a lifetime thing for them,” she added.
“So the facts need to come from clinicians. However, we note for
example that almost no clinical guidelines include a clear overview
of the differences in the risks of side effects among treatment, or
sections on communicating with patients, and this needs to change.”
SOURCE: http://bit.ly/2hAVarZ BJU International, online September
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