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Wednesday, March 29, 2006

Confusion Reigns in How Men Decide Treatment for Prostate Cancer

NEW YORK (Reuters Health) Mar 27 - When it comes to treating localized prostate cancer, treatment decisions frequently do not appear to reflect patient preferences, investigators report in an upcoming issue of Cancer.

There is no gold standard for optimal treatment of localized prostate cancer, choices of which include radical prostatectomy, external beam radiation therapy, brachytherapy, and watchful waiting, the authors of the study note. Despite a plethora of studies examining how men decide on a treatment plan when they are diagnosed with localized prostate cancer, there is no consensus on what issues actually guide their decisions.

Dr. Scott D. Ramsey, from Fred Hutchinson Cancer Center in Seattle, and his associates conducted a literature search and identified 69 peer-reviewed studies concerning the treatment decision-making process for localized prostate cancer. The findings will appear in Cancer on May 1.

Initially, cancer eradication is the primary concern of most patients. The investigators report that the advice men are given varies according to physician specialty, and usually does not include all pertinent information required to make an informed decision as to survival and quality of life, nor does it always take into account the seriousness of the patient's cancer.

Nevertheless, physician recommendation is a major influencing factor for more than half of patients interviewed. Study results suggest that physicians' advice varies, with blacks and men with lower income or education levels receiving less aggressive treatment.

Patients also are concerned to varying degrees about side effects, such as incontinence and impotence. However, fear of side effects only rarely affects treatment decisions, and the authors suggest that many patients don't understand side effect issues and they often do not receive accurate information.

Dr. Ramsey and his associates recommend "future prospective studies aimed at examining how patient values evolve throughout the period of time from their first being diagnosed with prostate cancer until the completion of treatment."

They suggest that researchers explore how patients' personal values affect their decisions, as well as the role of family members, patients' ethnicity and socioeconomic status, and the settings in which men receive treatment.



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