Prostate Cancer Treatments Often Compound Existing HealthProblems

Prostate Cancer Treatments Often Compound Existing HealthProblems
MONDAY, Nov. 26 (HealthDay News) -- More than a third of prostatecancer patients may receive treatments that are inappropriate because ofproblems they are already having with urinary, bowel or sexual function, anew study suggests.
These mismatches might occur, because patients don't give enoughinformation to their doctor or because their doctor favors a particulartype of treatment, according to the report in the Nov. 26 online editionof Cancer.
"We found an awful lot of patients whose treatment seemed to becontraindicated by urinary, bowel or sexual problems they had before theygot treated," said lead researcher Dr. James Talcott, from the Center forOutcomes Research at Massachusetts General Hospital Cancer Center inBoston. "That's pretty good evidence that information wasn't transmittedor didn't factor in with the treatment decision."
Unlike other cancers, there are several treatment options for prostatecancer. The treatment that is best for an individual patient is based onseveral factors, including stage at which the cancer is diagnosed, age ofthe patient, and existing problems with urinary, bowel or sexual functionthat the patient has.
Treatments include external radiation therapy; brachytherapy, in whichtiny radioactive particles are implanted into the prostate gland, and thesurgical removal of the prostate gland.
Although these treatments are effective, each has a different set ofside effects. External radiation can lead to bowel dysfunction,brachytherapy can cause urinary problems, and surgery can damage nervesinvolved in sexual function.
Treating patients who already have problems in these areas with aprocedure that could exacerbate their problem is usually notrecommended.
For example, treatment designed to preserve normal functions, such asnerve-sparing, prostate-removal surgery, is not appropriate for patientswho have already lost sexual function, Talcott said.
To find the extent of treatment mismatches, Talcott's team collecteddata on 438 prostate cancer patients. Patients were asked to completequestionnaires that included questions about urinary incontinence andother urinary problems, and bowel and sexual dysfunction.
The researchers found that 89 percent of the patients had some level ofurinary, bowel or sexual problem before starting treatment. Among thesepatients, 34 percent of those with one serious symptom had a mismatchedtreatment, as did 37 percent who had a less serious symptom. Moreover, 40percent of those who had several symptoms also received contraindicatedtherapy.
In addition, among patients with significant dysfunction in all threeareas for whom no treatment would be recommended, only 5 percent chosewatchful waiting. In this strategy, patients are not treated but arefollowed closely.
These mismatches appear to occur because doctors and patients don'tcommunicate well. Patients are often reluctant to talk about urinary,bowel and sexual problems, Talcott said. "And, sometimes patients overridetheir doctor's recommendation," he added.
Talcott also thinks that physicians can be wedded to a particulartreatment at the exclusion of others. "Surgeons believe in surgery, andradiation oncologists believe in radiation," he said. "That may be part ofthe problem."
To counterbalance physician bias, patients should get another opinion,Talcott said. "Patients should always get a second consult," he said."It's a good idea to talk with a surgeon, a radiation oncologist andpossible a medical oncologist."
One expert thinks that patients need to make an informed decision aboutwhich treatment is best.
"The kind of doctor that you see often predetermines the treatment youreceive," said Dr. Durado Brooks, director of prostate and colorectalcancer at the American Cancer Society. "Urologists are much more likely tohave a surgical solution, and those who see a radiation oncologist aremore likely to have radiation."
Patients need to be well-informed about their condition and thepossible treatments and their side effects, Brooks said. "Patients need toarm themselves with as much information as possible about what theirtreatment options are, and what some of the contraindications ofparticular treatments are," he said.
Men also need to know what all the treatment options are, Brooks said."Men need to be aware that, in some cases, depending on their overallmedical condition and the stage of their cancer, that it is, at times,appropriate not to have any active treatment," he said. "Watchful waitingis a legitimate option in a significant proportion of men."
"In addition, doctors need to work with their patient to choose thebest treatment option, Brooks said.
"If one takes the time to have a discussion, educate the patient andnot rush them into a decision, then you may be able to allow them to getpast their emotional response and make a more educated, logic-basedresponse," Brooks said.
Brooks noted that because there are so many treatment options inprostate cancer, patients may insist on a particular treatment even thoughit's not the best choice for them.
"Where treatments are contraindicated in other places in medicine,doctors don't provide a treatment for a patient just because that's whatthey say they want," Brooks said. "You explain that that treatment issimply the wrong treatment for you, and therefore, we are not going totake that approach."
More information
For more on prostate cancer, visit the American Cancer Society.