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Prostate Cancer Choice a Coin Toss?

Uncertainty, Faulty Info Confuse Men Facing Prostate Cancer Treatment

How Men Pick a Prostate Cancer Treatment continued...

Men who want to do more -- and most do -- face very different prostate cancer treatment optionsprostate cancer treatment options. 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.

"Making a prostate cancer treatment decision is quite difficult," Wilt tells WebMD. "It is made more difficult because it involves many different medical specialties with competing, well-intentioned beliefs of effectiveness, what doctors practice, and what they might get reimbursed for."

While the effectiveness of most treatments is roughly the same, the treatments do differ in important ways. These differences lie in their side effects.

"There just are a lot of side effects, period," Zeliadt says. "And that is downplayed in the discussion about prostate cancer treatment."

"In general, doctors are more optimistic about treatment benefits and -- at that minute they tell a man he has prostate cancer -- they devote less attention to the risks and side effects," Smith says.

Zeliadt found that men worried a lot about side effects. But they tended to choose a treatment not because of how well they think they can tolerate the side effect but because of how well they think it would work. And the factor that sways their decision doesn't always come from a reliable, unbiased source.

"Men hear all this different information, and they tend to latch onto something," Zeliadt says. "It may be something the doctor said, the fact that their uncle died of prostate cancer, or something a neighbor said. It seems sort of random. In one study we reviewed, they came up with list of 93 questions men had about prostate cancer. And no two questions were on the top of any one guy's list. They just have so many different information needs. It is all over the place."

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