Sept. 23, 2004 -- Far too many men with prostate cancer make treatment decisions without fully understanding their options, but better coordination among specialists who treat the disease could minimize the confusion, suggest two dozen researchers in a new report.
Improving communication among urologists, medical oncologists, and radiation oncologists could significantly affect treatment outcomes at all stages of the disease, says a spokesman for the Prostate Cancer Foundation, which released the report Wednesday.
With the exception of the nation's top prostate cancer treatment centers, this multidisciplinary approach is rarely seen, Prostate Cancer Foundation Vice President of Biopharmaceutical Research Gregg Britt tells WebMD.
"Only a small percentage of patients are treated at these centers, so this is a significant problem," Britt says. "It is hard enough given the volume of medical information coming out on prostate cancer for specialists to stay current in their own field, let alone to know what is happening across three separate disciplines."
Britt says the 80-page report was written as a comprehensive overview of prevention, diagnosis, and treatment research and will be distributed to every doctor in the nation treating prostate cancer patients.
Other major goals highlighted in the report include:
- The identification of better methods of diagnosing prostate cancer. Recent reports have questioned the value of prostate specific antigen (PSA) screening among asymptomatic men, with several concluding that the widely used test has led to overtreatment of the disease.
- Finding better ways to distinguish between fast-growing prostate cancers that require aggressive treatment and slow-growing cancers that may need no treatment at all.
- Providing better information about treatment options to the more than 200,000 men diagnosed with prostate cancer in the U.S. each year. Men with localized disease often face uncertain decisions about whether to have surgery, radiotherapy, other treatments, or no treatment at all without enough information on potential long-term side effects.
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Determining which patients need treatment and which ones do not is of special importance due to the growing number of American men approaching their second half-century of life. Most prostate cancers are diagnosed in men over the age of 50, but late-life cancers also tend to grow more slowly than those occurring in younger men.
A recent report illustrated why overtreatment is of such concern. Researchers from the National Cancer Institute found that the majority of patients remain impotent five years after having either radiation or surgery. A significant percentage of the patients in the study also had long-lasting urinary or bowel problems.
Another recent study suggested that a rapid elevation in PSA level over a relatively short period of time may be a better indicator of clinically meaningful prostate cancer than a single PSA reading.
The NCI is evaluating the merits of PSA screening in a study involving 75,000 men, but results are not expected for five years. Another major study is under way among men with elevated PSAs comparing surgery to no treatment.
"There is growing funding for prostate cancer research, and much of it is heading in the right direction," American Cancer Society Director of Prostate Cancer Durado Brooks, MD, tells WebMD. "But unfortunately, because of the complexity of this disease -- the fact that it is slow growing and mostly occurs in an older population -- it is difficult to get a handle on. It is not likely that we will have useful answers for several years."
Brooks says the report should be of value to clinicians treating prostate cancer because it gives them easy access to the latest research.
"Prostate cancer treatment decisions have to be made on a patient-by-patient basis, and the more information everyone has, the better," he says. "Some men are very uncomfortable with the idea of having cancer in their body, while others may be OK with watching blood tests for a while."