THE "NEW" PROSTATE CANCER INFOLINK

A new study based on data from nearly 500 patients gives us some insight into how a selected group of men less than 50 years of age were thinking about treatment for prostate cancer between 2001 and 2005. Whether one would get the same results for a similar group of patient diagnosed today is a good question.

The paper by Sidana et al. is based on a cohort of 986 men — all under 50 years of age and all confirmed to have Gleason 3 + 3 = 6 prostate cancer after they had sought a pathologic opinion on their biopsy specimens from Dr. Epstein and colleagues at Johns Hopkins Medical Center between 2001 and 2005.

We need to recognize immediately that these were hardly “average” patients. They were clearly motivated in some way to get a specialist opinion on their biopsy cores (although it is not clear whether this was always at the patient’s request or might have been at the suggestion of their own doctor).

Sidana et al. mailed a detailed questionnaire to all 986 patents, with the following results:

• 493/986 men (exactly 50 percent) responded.
• The men with some degree of college education or with an annual income >$100,000 were significantly more likely to have
• Consulted three or more doctors before making a treatment decision
• Considered sexual function to be important in making a treatment choice
• Men reported that “doctor’s recommendation” was the most influential information source in making their treatment decision.
• The Internet was reported to be the second most frequent source of information.
• The vast majority of these patients had selected one of three common forms of first-line management:
• Radical prostatectomy (n = 393, 81.4 percent)
• Radiation therapy (n = 52, 10.7 percent)
• Active surveillance (n = 26, 5.3 percent).
• With respect to the actual decision-making process
• 2 percent of patients preferred a passive role.
• Patients who chose radiation and active surveillance preferred “informed decision-making.”
• Patients who chose surgery preferred “shared decision-making.”
• The “doctor’s recommendation” was of less importance to men electing active surveillance as a first-line management option.
• Most patients (89 percent) stated that they did not regret their decision.
• There was no significant difference in satisfaction levels between patients who had selected different types of therapy.

It is hard to know exactly what to make of these data since it is divorced from any data about the patients’ immediate and long-term outcomes.

The fact that patients report that “doctor’s recommendation” and the Internet were their two primary influential information sources is hardly a revelation. Nor is the fact that there was a high level of satisfaction regardless of the type of treatment selected.

In the period from 2001 to 2005 it is probably fair to say that the application of radical surgery as a first-line treatment for low-risk prostate cancer was at a very high level of acceptance, and that many men were not fully aware of the potential risks to sexual function associated with radical surgery. We also assume that the 52 men in this sample who elected radiation therapy included men who had proton beam radiation therapy or brachytherapy, and not just standard forms of external beam radiation therapy.

What can not be told from this study is whether these young men made “good” decisions. All we can tell is what their decision was and what influences may have played a factor in reaching that decision.

Filed under: Diagnosis, Management, Risk, Treatment | Tagged: choice, decision-making, influence, option, young |