Fear Factor in Early Prostate Cancer

Fear, Misunderstandings Affect Patients' Treatment Choices

Medically Reviewed by Louise Chang, MD on August 04, 2006

Aug. 4, 2006 -- Men with early prostate cancer may choose treatments based partly on fear and misconceptions about their options.

So says a study in the journal Cancer.

Doctors should help patients set fear aside and weigh all the facts before choosing a treatment, write the researchers, who work at University of Colorado Health Sciences Center in Denver.

Thomas Denberg, MD, PhD, and colleagues interviewed 20 men with newly diagnosed, early- stage prostate cancer. The men's cancer hadn't spread outside the prostate.

All of the men were urology outpatients at Veterans Affairs Medical Center in Denver. They ranged in age from 54-80 years (average age: 65).

Treatment Options

The men were all eligible for at least two of the following options:

  • Prostatectomy: surgery to remove the prostate
  • External-beam radiation: radiation beamed at the tumor from outside the body
  • Brachytherapy: implanting permanent radioactive "seeds" in the prostate
  • Hormonal ablation: hormone therapy to slow the cancer's growth by curbing testosterone
  • Cryotherapy: freezing cancer cells with liquid nitrogen
  • Watchful waiting: monitoring the cancer without immediate medical treatment

The researchers interviewed the men before and after the patients chose their treatments.

The first interview happened within a week after the men first started talking to doctors about treatment options.

That interview, which lasted 60-90 minutes, covered the men's feelings about their prostate cancer diagnosis and treatment options.

Six to eight months later, the researchers followed up with a brief phone interview.

Fear Factor

The researchers spotted three factors that seemed to be big influences on the men's treatment choices. All three factors had drawbacks.

The first factor was "profound fear and uncertainty, often corresponding with a desire to receive treatment as quickly as possible," write Denberg and colleagues.

Most patients (16 out of 20) didn't want to get a second opinion because they didn't want to waste time and add uncertainty to their situation, the researchers note.

Prostate cancerProstate cancer often grows slowly. Most of the patients in Denberg's study knew that. But knowing something in your brain doesn't always override fear.

"Even though most patients volunteered that prostate cancercancer is 'slow growing,' this abstract knowledge did little to dispel the vividly frightening, yet unlikely prospect of prostate cancer suddenly 'exploding,'" the researchers write.

Misconceptions About Choices

The second factor was "influential misconceptions about treatment, especially prostatectomy," the researchers note.

For instance, eight men (40% of the group) said that they thought surgery was to get rid of the cancer for good.

That's not necessarily true, say the researchers. They cite other research on the effectiveness of radiation therapy for early prostate cancer.

Another 11 men (55% of the group) had "equally strong but negative feelings" about surgery, calling it "drastic" and even voicing fears about dying in surgery, the researchers note.

The interviews also revealed other mistaken beliefs among the men. For instance, some patients confused radiation therapy with chemotherapy, the study shows.

Relying on Anecdotes

The third factor was relying on stories (anecdotes) about other people who had had prostate cancer.

People may naturally want to base personal decisions on the real-life experiences of other people. But that strategy isn't always a good idea.

Each person's situation is different. There's not always a one-size-fits-all approach to cancer treatment. What worked for one man might not be the best choice for another.

In Denberg's study, the anecdotes the men mentioned didn't always fit their own situation.

"For the most part, these stories did not accurately match patients' own clinical circumstances," the researchers write.

Still, the men's initial feelings about their treatment choices hadn't changed by the follow-up interview, the study shows.

Doctors should work to dispel myths and ease fears in men making treatment choices about early prostate cancer, Denberg's team concludes.

Show Sources

SOURCES: Denberg, T.Cancer, Aug. 1, 2006; vol 107: pp 620-630. WebMD Medical Reference: "Understanding Prostate Cancer -- Treatment."
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