More than one third of men diagnosed with prostate cancer in the early stages end up making medically inappropriate treatment choices. A new study reports that these treatment ‘mismatches’ could likely be a result of a patient’s unwillingness to discuss pre-existing conditions with their doctor.

The study was led by Dr. James Talcott of the Center for Outcomes Research at Massachusetts General Hospital. “Prostrate cancer patients experience the same fears and hard decisions as all cancer patients do but prostate cancer treatment directly affects very personal things that most people aren’t comfortable talking about – urinary, bowel and sexual function,” says Talbot.
 

The standard treatments options for early stage prostate cancer are external radiation therapy, Brach therapy in which tiny radioactive particles are implanted into the prostate gland, and prostatectomy or surgical removal of the gland. While all the treatments have similar levels of effectiveness the side effects are different. Radiation can cause bowel dysfunction, Brach therapy can lead to urinary problems and surgery could affect sexual function. If a patient already has lost some function in any of those areas, the choice of therapy should be picked accordingly to avoid making the condition worse.

440 men participated in the study from beginning to end. Each was asked to fill out a questionnaire designed to assess urinary problems as well as bowel and sexual dysfunction at 4 intervals ranging from 3 to 36 months from beginning treatment. Other questions addressed several factors that might affect treatment decisions. The patients also gave researchers access to their medical histories. The patients were divided into 4 groups depending on their level of function in both individual and multiple symptom areas. The treatment mismatches were at the same level in all of the groups.

“It could be that treatment choices are determined by factors other than those we asked about, or patients may decide to go ahead with mismatched treatments for their own reasons, knowing the risks” says Talcott. “But it also could be that open, frank conversations patients should be having with their doctors aren’t taking place or that doctors aren’t making it clear to patients why they should be forthright about urinary, bowel of sexual problems they are having.”

Talcott and his colleagues suggest one solution may be to have patients address sensitive topics on a questionnaire which may be more comfortable for them than talking about it.

SOURCE: January, 2008 issue of the journal Cancer, released online Nov. 2007.