Prostate Information
Is for Ladies, Too
With almost a quarter of a million husbands and fathers
being diagnosed with prostate cancer every year, women
— considered to be the primary decision-makers on
health care in most families — are paying closer attention
to the latest research in this disease.
The notion of basing the need for either follow-up or
treatment solely on the basis of a prostate-specific antigen
test, or PSA, is obsolete. So is the idea that most
treatment protocols produce the same satisfaction for
everyone. One size does not fit all.
Ian M. Thompson, M.D., has spent the last five years
chairing a blue ribbon panel of national experts to update
guidelines for treating patients with prostate cancer.
“Most men are at low risk of dying from prostate cancer,
and we need to help them understand that they have
a choice in treatment and to emphasize that the outcomes
should be excellent with all treatment options.”
Thompson is director of the Multidisciplinary
Genitourinary Clinic and the new Second Opinion “GU”
Clinic at the Cancer Therapy & Research Center and a
professor at the University of Texas Health Science
Center at San Antonio. A leading expert in prostate cancer
and urologic oncology, he has authored or coauthored
hundreds of publications based on his research
and even published an entire book on prostate cancer.
Thompson stresses that patient preference
should play
a prominent role in the
process of choosing a prostate
cancer
therapy because the decisions are
based on
trade-offs – “controlling the
cancer vs. side effects.”
“People often go to physician’s offices to get a recommendation
on how to treat their prostate cancer,”
Thompson says. “Unfortunately, that recommendation is
often based on physician preference more than on data.
Instead, you need to take into account patient preferences,
current physical status, life expectancy, as well as
tumor characteristics before making a recommendation.
“A slow-growing tumor in an older patient who has
multiple medical problems would probably be treated differently
than a slow-growing tumor in a young patient. A
patient whose No. 1 priority is controlling the cancer may
select a different treatment than a patient whose No. 1
priority is maintaining his current quality of life or not
impacting his sexual, urinary or bowel functions.”
Furthermore, the physician points out, fact-based
studies fail to show the superiority of one treatment over
another. In fact, patients’ tumors are so different that
comparisons between two treatments may not be applicable
at all. Those two factors combine to place even
greater emphasis on educating the patient and hearing
his personal preferences.
“You can show the educational information to two guys,
same age, same PSA, same Gleason score (which indicates
the aggressiveness of the tumor). They have the
same family history, they’re both married and have four
kids, and they’re both very intelligent. They’ll come up with
two completely different decisions on what they want.
That’s called individualized medicine. It’s called helping the
patient decide what’s right for him and for his family.”
In the area of diagnosis, Thompson conducted a study
released last fall showing that a man’s PSA fails to provide
an absolute delineation between normal and abnormal
results. Some men with low PSA values could still be
diagnosed with prostate cancer, while those with high
PSA numbers may not have the disease. His study urges
physicians to consider a number of factors in addition to
PSA when discussing risks and options with patients.
He also created an online assessment tool so that men
can more accurately predict their risk for developing
prostate cancer than by PSA and digital rectal exam
alone. The site, www.compass.fhcrc.org/edrnnci/bin/
calculator/
main.asp, allows men to also enter race, age,
biopsy history and family history for prostate cancer into
the assessment mix in order to make that calculation.
As the family member who most often takes the lead
on healthcare issues, a woman has plenty of reason to
keep pace with current guidelines and studies on
prostate cancer. That information could save the life — or
the lifestyle — of someone she loves.
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