Prostate Cancer Choice a Coin Toss?
Uncertainty, Faulty Info Confuse Men Facing Prostate Cancer Treatment
How Men Pick a Prostate Cancer Treatment continued...
"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."
Choosing a Prostate Cancer Treatment
Every expert who spoke to WebMD said the same thing. Eventually, a man facing prostate cancer will ask his doctor, "Doc, what would you do?"
"It is my personal belief that a doctor should not say what he or she personally would do," Wilt says. "Unless they come back with a treatment choice that I think is out on the far end, I just would not know what I would do, or what I would tell my father to do -- because my father and I are not you."
Wilt, Smith, and Zeliadt say it's essential for a man to consider each of the possible side effects of treating, or not treating, early prostate cancer. They also agree it's essential for every man to make his own choice.
"My job is to give you the information in the most balanced way and to understand what is most important to you," Wilt says. "That allows me to support you in that choice no matter what happens."
Zeliadt suggests that men focus on their own situation and on their particular needs.
"I would encourage men to forget all the information they have heard from other men. It probably does not apply to their scenario," Zeliadt says. "They should really think about how they would adjust to the different side effects of treatment and have that be an important consideration. There is probably not a wrong decision about survival you can make. All the different treatment options are pretty close to being excellent. And that includes watchful waiting."