CURExtra - Prostate Cancer Therapy: Men Guided by What They Fear, What They Hear

Many men let their fear of prostate cancer or stories from others guide their judgment when it comes to making decisions about treatment. Rather than carefully weighing the potential side effects and effectiveness of each option, a recent study in the journal Cancer found that many men based their choices on stories they'd heard from other prostate cancer patients and notions they already held about specific treatments.

Counteracting those fears is a tall order, acknowledges lead study author Thomas Denberg, MD, PhD. But he thinks helping men sort through their concerns point-by-point may be one way to help them make better treatment decisions.

"We need to be very explicit with men that certain beliefs aren't right and give very detailed explanations of why those beliefs aren't correct," says Dr. Denberg, assistant professor of internal medicine at the University of Colorado Health Sciences Center in Denver. "Giving them information isn't enough to get rid of these fears. We really need to address them directly and upfront."

Preconceived Ideas About Treatment

Early stage prostate cancer can be treated in a number of ways, including removing the prostate surgically, external beam radiation or radioactive seed implants (brachytherapy), and cryotherapy (freezing the tumor). All of these have the potential to cure the patient. Hormone therapy and watchful waiting are not considered curative, but are also options for certain men.

Dr. Denberg and his colleagues surveyed 20 men newly diagnosed with early-stage prostate cancer about what factors influenced their treatment choices. The men were all patients at a Veterans Affairs hospital and were between the ages of 54 and 80. Each had been given written information about treatment options and had had one consultation with a urologist.

All of the men in the study were eligible for at least 2 forms of treatment intended to cure the disease. Yet many of the men expressed a strong preference for one treatment over another even before they'd had time to weigh all the pros and cons. Some men wanted surgery because they thought it would be most likely to get rid of all the cancer quickly. Other men rejected surgery outright because they were afraid of it or because they felt it was too extreme. Some men preferred brachytherapy over external beam radiation because they thought it would be more direct and have fewer side effects.

In reality, though, each of these treatments has a good chance of curing the patient, and each has its own risks and benefits. Doctors need to help men see through misconceptions "so they can really validly weigh their options," says Dr. Denberg.

Wanting to Act Fast

Fear of dying from the cancer may have kept many of the men from giving careful consideration to their treatment options. More than half of the men wanted to be treated as quickly as possible, even though they knew that most prostate cancers—though not all—tend to grow slowly. Men whose cancers do not seem particularly aggressive may not need to rush their decisions.

Likewise, many men didn't give a lot of thought to treatment side effects because they were more afraid of dying from their cancer than they were of dealing with problems like impotence or incontinence down the road. But Dr. Denberg says treatment side effects should be an important consideration, since most men with early-stage disease live a long time after treatment.

Prostate cancer can be deadly, of course, but the number of men who die from it is vastly smaller than the number of men who get it. More than 234,000 new cases and about 27,000 deaths are expected in the United States in 2006. Men with early-stage disease have a particularly good outlook—nearly 100 percent of men with this type of prostate cancer survive at least five years after treatment.

Other People's Experiences

Another factor that had a strong influence on the men's decisions was how other men they had known had dealt with the disease. All but one of the men in the study had known or heard about someone with prostate cancer. Many of the men used that person's experience as a guide for their own decisions, even though their situations—how advanced the cancer was, what stage it was in at diagnosis—may have been entirely different.

That doesn't come as a surprise to Mark Litwin, MD, a urologist at the University of California, Los Angeles, Jonsson Comprehensive Cancer Center who counsels patients every week about prostate cancer treatments. He was not involved in the current research, but called it important information for doctors and patients trying to sort through prostate cancer decisions.

"I think anecdotal evidence can be helpful, but it ends up playing much too great a role in people's decision-making process," Dr. Litwin says. "Talk to other men, but don't just talk to one. Talk to someone who's had a good experience with surgery and someone who's had a good experience with radiation and vice versa. Talk to people who've had suboptimal experiences."

Getting multiple perspectives in this way can help men make more balanced decisions, he says. The same goes for getting a second opinion. Yet only 4 of the 20 men in the study wanted to consult another doctor.

"A lot of men were under the assumption that the second opinion has no purpose other than to confirm the diagnosis," Dr. Denberg says. "They didn't understand that the true purpose is to get another clinician's perspective about treatment options."

Doctors tend to be most familiar with the type of treatment they provide, he explains, so a surgeon (urologist) may not be as well-versed in the benefits and risks of radiation, and a radiation oncologist may not know as much about surgery. Getting different points of view may help men make better treatment decisions.

"Dealing with the diagnosis and figuring out what you're going to do is a process," he explains. "It's not something that can happen in one clinic visit with a urologist."

Dr. Litwin also suggests men speak with their primary care physician about their different treatment options. "It's important for everyone who is newly diagnosed to have a conversation not only with a surgeon, but also with a radiation oncologist," he said. "I require [my patients] to do it."

In the end, though, men have to make a treatment decision that feels right for them, Dr. Litwin says. "If you're not the type of person who feels like he can live with decision A or decision B, then you should incorporate that into your choice," Dr. Litwin says. "People are often predisposed one way or the other, but that should be balanced as much as possible by unbiased information."

For more information on issues of cancer treatment, visit the American Cancer Society's website at www.cancer.org.

©American Cancer Society

Watch for CURE's upcoming feature on making medical decisions in the Fall 2006 issue.