Information helps men make prostate cancer decisions

NEW YORK (Reuters Health) - When given additional information, prostate cancer patients are less likely to remain undecided about which treatment they want and are less likely to want their prostates removed, in a new study.

Perhaps not surprisingly, Dutch researchers found that just 2 percent of patients remained undecided after being educated about the two or three treatments available to them. That's compared to about 8 percent of patients who had normal doctor's visits.

Additionally, 65 percent of patients in the educated group preferred to have their prostates removed - a surgery known as a radical prostatectomy - compared to 73 percent of patients who were not given additional information.

"The contribution this study makes is that it fits with a number of other trials that have been done with surgery," said Floyd J. Fowler, senior scientific advisor for the Informed Medical Decisions Foundation (IMDF) in Boston.

Fowler, who was not involved with the new work, said past research shows people usually pick more conservative treatments after they're exposed to more information.

For example, the new study found that the educated patients were more likely to prefer one of two radiation treatments that may allow them to keep their prostate instead of having the gland completely removed.

To see whether a "decision aid" - a structured meeting that provides patients with the pros and cons of various treatments - helped those with prostate cancer to decide on a treatment choice or changed their existing choice, the researchers monitored 240 patients at three Dutch hospitals between 2008 and 2011.

The researchers, led by Julia J. van Tol-Geerdink at Radboud University Medical Centre in Nijmegen, The Netherlands, randomly assigned 163 patients into a group that received the additional education, while 77 were assigned to a comparison group that had regular doctor's visits.

In each group, urologists met with prostate cancer patients and told them about the available treatment options, but did not decide on one during those first visits.

Those in the education group then had a second visit with a researcher who described each treatment through a standardized discussion, while those in the comparison group had a normal follow up visit with their specialists.

The patients' treatment preferences - along with which side effects they were most concerned about - were then recorded.

Overall, 65 percent of those in the education group preferred to have their prostates removed, 33 percent preferred a form of radiation and 2 percent remained undecided.

In those who had normal doctor's visits, 73 percent preferred a radical prostatectomy, 20 percent preferred radiation and 8 percent were undecided.

As for what the patients were most concerned about, researchers found that - aside from survival - bowel and urinary problems were most important, while sexual problems and the procedure itself were less so.

van Tol-Geerdink did not respond to requests for comment by deadline.

WATCHFUL WAITING?

The study is part of a long body of research that says involving patients in decision making leads to making better decisions, Dr. Michael J. Barry, a primary care doctor at Massachusetts General Hospital in Boston and IMDF president, told Reuters Health.

"People should know what all of their options are, and with prostate cancer there are a lot of options," Barry, who was also not involved with the new study, added.

But both Barry and Fowler said the study would have been better if the researchers also offered patients the option to just monitor the cancer's growth - an approach known as "watchful waiting."

"I think you might have seen more interesting results if they included that," said Fowler.

Despite that limitation, researchers, writing in the British Journal of Urology International, recommend that hospitals and doctors use similar "decision aids" to help patients reach a decision.

As for now, Fowler said patients should ask their doctors for information on all of their treatment options.

"I think if a patient goes in and says, 'I want to understand the pros and cons of all my options - including doing nothing,' most (doctors) would do it," he said.

The American Cancer Society projects that 241,740 men will be diagnosed with prostate cancer in 2012, and 28,170 will die from it.

SOURCE: http://bit.ly/POeCfb British Journal of Urology International, online August 10, 2012.

Source: http://news.yahoo.com/information-helps-men-prostate-cancer-decisions-202124256.html

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