Prostate Cancer Choice a Coin Toss?
Uncertainty, Faulty Info Confuse Men Facing Prostate Cancer Treatment
March 27, 2006 -- It may be the most important decision of their lives, yet most men base their choice of prostate cancer treatments on incomplete information.
The finding comes from a review of studies looking at how men decided what to do when they learned they had early-stage prostate cancer.
One huge complicating factor underlies the decision how -- and whether -- to treat prostate cancer: There's no clear evidence that any one treatment is more effective, or has fewer side effects, than another has.
At least for some men, there's not even good evidence that treatment is better than watchful waiting, says Steven Zeliadt, MD, PhD, research scientist at the Fred Hutchinson Cancer Research Center in Seattle, who worked on the study.
"As a culture, we just don't like not knowing. So we tend to ignore that there is no information, and we find some way of being encouraging about treatment," Zeliadt tells WebMD. "Over and over and over again in these studies, men would bring up the issue of treatment side effects. But when it came down to it, among the factors that made them decide, side effects played a very small role. Ironically, that is the only area of treatment we have a lot of information about."
It's an important study, says Robert A. Smith, PhD, director of cancer screening for the American Cancer Society.
"What this particular article is addressing is very, very important," Smith tells WebMD. "People bring different preferences to bear in prostate cancer treatment decisions. But it is not clear these preferences are matched with the broad amount of information on what to do. It is hard."
The Zeliadt study appears in the May 1 issue of the journal Cancer.
How Men Pick a Prostate Cancer Treatment
Once a man hears the words, "
," he's faced with a choice. Because prostate cancer usually grows very slowly, he may choose watchful waiting. That means doing nothing more than having frequent checkups to make sure the cancer isn't spreading. Most men, after all, die with prostate cancer, not from it.
Men who want to do more -- and most do -- face very different
. For most men, these choices boil down to surgery or radiation therapy.
Most men, Zeliadt and colleagues found, want to pick the treatment that is most effective at curing their cancer. And this is where the system breaks down.
Urologists who do surgery are most likely to say that surgery is the best treatment. Radiation oncologists are more likely to say that one or another radiation therapy is best. Yet there's no reliable proof that any of these relatively effective treatments is better than another, says prostate cancer researcher Timothy J. Wilt, MD, MPH, professor of medicine at the Minneapolis VA Center for Chronic Disease Outcomes Research.