Men aren't being offered all options for treating prostate cancer
Australian men with a recent diagnosis of prostate cancer that require active treatment, as opposed to careful monitoring, are often not given all the options available to them, writes Associate Professor Sandra Turner.
Australian men with a recent diagnosis of prostate cancer that require active treatment, as opposed to careful monitoring, are often not given all the options available to them.
This means not all men are getting the necessary information and support to make a decision on what treatment is best.
础听听听of听听and听听support the fact that less invasive radiation therapy is听听in curing or controlling cancer as surgical removal of the prostate, known as radical prostatectomy.
While all patients see a urologist - the specialist surgeon who does the biopsies and gives the diagnosis - they only see a radiation oncologist if the urologist or GP refers the man on. In this way, the urologist is the gatekeeper to men receiving optimal (or sub-optimal) care. The fear of cancer and a natural emotional response to get it out may lead to a听听for surgery, and to possible听听later on.
Bias in medicine is a reality, and it is not surprising听. But it is problematic when bias creates a hurdle to men getting accurate, balanced information. There is plenty of evidence men aren鈥檛 getting the chance to hear about their radiation therapy options. 础听听found that men seeing both a radiation oncologist and urologist were six times more likely to choose radiation therapy compared with men seeing only a urologist.
In Australia, the proportion of听听is much lower than research on effectiveness of radiation therapy听听if men with prostate cancer were exhibiting truly informed choice. Meanwhile, prostate surgery rates are higher and continue to rise, especially in the听.
The gold standard of care
The听听for prostate cancer begins with the patient and his support person听听鈥� the surgeon (urologist), a radiation oncologist and a specialist nurse. In doing so, the man is provided with the relevant information and听听he needs to make an informed decision about his preferred treatment.
Virtually all specialist doctors who treat cancer profess to be part of a听, that includes surgeons, medical and radiation oncologists and other experts, and attend meetings where the relevant听听patient 鈥渃ases鈥� to decide on management. These team meetings are valuable, but they are only one aspect of a high quality service. Meetings do not听, the man with prostate cancer, who is integral to the听.
The multi-disciplinary team model听听in the treatment of breast cancer. There is听听more than one听听available for men with prostate cancer, sometimes several. For men with low risk cancers, many may not require active treatment up front (or ever) and are appropriately managed by active surveillance or careful monitoring.
But other听听听to reduce the chance of dying, or suffering symptoms, from cancer. Alternative treatment pathways are very different for the individuals involved, in terms of听, potential听, the need for听, and potential听. This is why the man with prostate cancer has to be the most important member of the team who decides on the treatment.
Putting the patient at the centre
Only the patient can weigh up the trade-off between the risk of bowel problems (with radiation therapy) and the risk of urinary incontinence (with surgery). Likewise, the choice between attending the cancer centre for radiation treatment every weekday over several weeks versus hospitalisation and time off work for recovery after surgery. There are many other听听that may sway a man to prefer one approach over another.
As already mentioned, the听听for prostate cancer treatment is that the听听with a urologist and a radiation oncologist. As the two types of prostate cancer specialists have distinct expertise in different areas, seeing both is the only way men can get complete,听.
The man can then consider his options and discuss these with his family and GP if he wishes. The good news is that men can take time to do this, as most prostate cancers are relatively slow-growing.
In the听,听, and听听听in Australia, prostate cancer teams do place the man听听of decision-making. But this must become the rule rather than the exception and Australian men should be strongly encouraged and assisted to see all experts.
Ultimately, men need to be empowered in their decision-making through being part of a process that enables and supports them in making fully informed choices. Until then, men who require active prostate cancer treatment need to insist on seeing all the specialists in the area, including a radiation oncologist.
This article was written by and first published on .
