Over the past decade, more men have opted, with the support of their family doctor, to have a prostate specific antigen (PSA) blood test along with a digital rectal examination to screen for prostate cancer. Early diagnosis has resulted in the vast majority of men being diagnosed with early-stage or low-risk disease, when they still have an excellent life expectancy regardless of the treatment they choose. Men with other chronic conditions continue to have a higher risk compared to those who are otherwise healthy. Although prostate cancer is the most commonly diagnosed cancer in men, the diagnosis is still upsetting for both the patient and his family members. Once the diagnosis is made, the next step involves becoming educated and making a treatment decision.
The four major types of information that men and their partners want at the time of diagnosis involve:
- the prognosis: “What impact will prostate cancer have on my survival?”
- disease stage: “What’s the extent or spread of my prostate cancer to other parts of my body?”
- treatment options (physician recommended and/or available)
- the odds of developing treatment-related side effects
You are unique
The amount of information and types of resources men wish to access varies. Some want as much knowledge as possible, while others want the minimum needed to make a treatment decision. Still others prefer the specialist to take the lead in deciding what treatment should be used. There’s no right or wrong way to approach getting information or making a treatment decision. The important thing to remember is that each person is unique and has different priorities based on their life experiences, current health status, relationship status, and friends’ experiences with prostate cancer treatments.
Radical prostatectomy (open or laproscopic), external beam radiation therapy (EBRT) and brachytherapy (BT) continue to be the most common treatments for early-stage prostate cancer. Newer treatments such as cryotherapy, thermoablation and high intensity focused ultrasound (HIFU) are available at some larger centres. Active surveillance (AS) is also considered a viable alternative for men with low-risk prostate cancer. AS is a proactive management approach with curative intent where active treatment is delayed until the prostate cancer shows signs of significant growth.
Both national and international clinical trials are currently enrolling patients with low-risk disease in studies to determine if there’s a select group of men who may never need treatment. Such studies are important, as they may help some men avoid the side effects associated with current treatments.
Quality of life
The two major side effects of most treatments include erectile dysfunction and incontinence or urinary bother. Both of these can have a significant impact on men’s quality of life, although to varying degrees. Given individual differences and pre-existing medical conditions, it’s often difficult to predict with certainty who will experience the most problems and the rate of recovery. Each specialist will also provide different percentages. It’s important to ask your own doctor what she/he expects your chances are of developing each of these side effects, based on your personal health history and the patients they have treated. One major requirement is that you have a frank discussion about the impact of treatment on future sexual function, expected changes in orgasmic function or sensation, and pain during intercourse.
Where to turn?
So, where can one get reliable information? Most people are now using the Internet to learn about treatments. Since there are so many sites available, it’s often a good idea to ask your specialist for a list of sites that she/he believes to be of high quality. This will save you time and ensure the information you receive is accurate. Also, make a list of your questions — this is a good way to make the most of your time with your specialist and guarantee you get the facts you need. Some patients make recordings of their treatment consultation. Whatever method you use, make sure to take the time to find out everything you need to know to make the best possible treatment decision for you.
B. Joyce Davison, RN, PhD, is Assistant Professor in the Department of Surgery, and Research Scientist in the Prostate Centre at Vancouver General Hospital, British Columbia.
