Where do newly diagnosed patients seek information?

A recent report in Urology focused on the role of information sources in the treatment decision-making process of men diagnosed with localized prostate cancer.

Ramsey et al. conducted a prospective survey of men diagnosed with localized prostate cancer in three geographically separate regions in the US. Most men were surveyed after diagnosis but before starting therapy.

The results of this survey showed that:

  • On average, men with localized disease consulted nearly 5 separate sources of information before treatment.
  • The most common source of information was (not surprisingly) the patient’s physician (97 percent) — and we assume this to mean the physician who carried out the diagnosis.
  • Other common sources of information included “lay literature” (pamphlets, videos) (76 percent), other health professionals (71 percent), friends with prostate cancer (67 percent), and the Internet (58 percent).
  • Most men rated the sources they consulted as helpful.
  • Consulting the Internet was associated with considering more treatment options.
  • Several information sources were significantly associated with consideration of particular treatments.
  • More than 70 percent of men stated that they were considering or planning only one type of therapy.

The authors conclude that “Men with local stage prostate cancer consult a wide range of information sources. Nonphysician information sources appear to influence their treatment considerations, but to a smaller degree than clinical factors.”

What is worrisome here is the inevitable degree to which, since urologists are the physicians who most commonly carry out the diagnosis, many patients may be receiving unnecessary or inappropriate treatment based on the inevitable and well-known bias of the urology community toward surgical intervention. Now we do not mean to imply by this that we think the urology community is deliberately misleading patients. However, it is clear that most urologists, faced with a patient who thinks he needs treatment for localized prostate cancer, are going to suggest surgery as a  primary option, and it is less clear how many urologists will also advise that patient in detail of the other options that may be available to him.

Whether the urology community likes it or not, even at the best centers in the country, radical prostatectomy is associated with risk for a series of significant side effects, some of which can have serious long-term implications. Every patient should receive clear guidance about all his options when it comes to treatment, and he would be wise to get a second opinion from another physician before commiting himself to a specific course of action.

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