THE "NEW" PROSTATE CANCER INFOLINK

In one more of those utterly unsurprising research findings, a study of newly diagnosed patients has shown that poor patient knowledge about the nature of prostate cancer is associated with “decisional conflict” leading to stress and anxiety given the uncertainty associated with the relative “value” of the many possible management options.

Kaplan et al. surveyed 70 patients who were enrolled in a randomized trial testing a novel, shared decision-making tool at a US Veterans Administration facility .

The baseline results of their study were as follows:

• Average (mean) patient age was 63 years.
• 49 percent of the patients were African American.
• 70 percent of the patients reported an income less than $30,000 per annum.
• Poor prostate cancer knowledge was associated with
  • Increased decisional conflict (P < 0.001)
  • Higher uncertainty (P = 0.001) about the quality of their decision
  • Lower perceived effectiveness of treatments (P = 0.003)
• Being in a relationship was also associated with a higher level of decisional conflict (P = 0.03).

In an associated media release issued by the University of California, Los Angeles, The lead author was quoted as follows:

For prostate cancer, there is no one right answer when it comes to treatment. It comes down to the right answer for each specific patient, and that is heavily dependent on their own personal preferences.

Men in general, and specifically economically disadvantaged men, have a hard time deciding what their preferences are, how they feel about any possible complications and what the future after treatment might be like. If you don’t know anything about your disease, you’ll have a really tough time making a decision.

If you get shot in the gut, there aren’t many options. You go into the operating room to get fixed up. With prostate cancer, there are lots of options and not all are right for everybody.

None of this is going to come as any big surprise to most of the regular readers of this blog. Not only does a newly diagnosed patient often need to decide whether he really needs immediate treatment at all (especially if he has low- or very low-risk disease, or has a limited life expectancy because of other health issues). And then if it does seem evident that he really does need early intervention he has to make decisions between many different possible treatment options.

Even those of us who have been studying this type of question for years are rarely able to tell an individual, newly diagnosed patient which form or forms of management might be the most appropriate for him (although we may be able to eliminate one or two theoretical options). Clearly it becomes much more difficult for a newly diagnosed patient who has little to none of the relevant knowledge on which to base his decision.

Alas, the study by Kaplan and his colleagues is also unable to offer us any real insights into how best to inform and educate newly diagnosed patients with regard to all their options. No one is suggesting that this is going to be easy, and we are very suspicious that there is ever going to be any one type of decision aid that can help the vast majority of newly diagnosed patients. Why? Because there is a huge emotional and “non-logical” component to this decision that is driven by individual men’s perceptions of what it means to be a “man” and the risks they are willing to take to preserve their “maleness” in the face of differing levels of actual risk from a particular diagnosis.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment | Tagged: decision-making, Diagnosis, knowledge, risk, Treatment |