COMMENTARY

Reframing Prostate Cancer as 'Chronic Disease'

Timothy Daskivich, MD; Matthew J. Resnick, MD

Disclosures

May 22, 2013

In This Article

The Importance of Better Informed Patients

Dr. Resnick: In the context of the high likelihood of treatment-related harms, I think there is a real opportunity to improve the acceptance of active surveillance or expected management strategies in men with prostate cancer.

Dr. Daskivich: The importance of transparency to patients up front, giving them the likelihood of having side effects and the likelihood of benefit from treatment, and finding good ways to communicate this information, is critical. Just talking about percentages doesn't mean much. We need to find ways that actually touch the patients and make them understand what their lives are going to be like 10-15 years down the line.

Dr. Resnick: No question. And there is a real opportunity as well to take some of the population-based data that we have and individualize them. We know that there are predictors of poor sexual function or urinary incontinence after treatment, either with radiation or surgery, for localized prostate cancer. Taking some of the population-level data and individualizing them so that patients can look at their risk for prostate cancer death or the risk for metastatic disease, compared with the risk for urinary incontinence, bowel dysfunction, or sexual dysfunction, is going to be valuable for these men.

Dr. Daskivich: Another important point is the difference between low-, intermediate-, and high-risk disease. Many clinicians understand it but the patients don't. Long-term randomized controlled trials have been done in men with low- to intermediate-risk disease, but those are a separate entity from high-risk disease, which poses a significant threat to survival over 10 years. It's a different animal.

Dr. Resnick: I think you're right. Reframing this disease for patients in a digestible manner is going to be how we have to move forward. I think that we can explain to patients, even before they have a diagnosis of prostate cancer, that there are certain types of prostate cancers that don't need to be treated.

Dr. Daskivich: Right.

Dr. Resnick: It's important because when patients come back to the office or get that phone call saying that they have been diagnosed with prostate cancer, it's very hard at that point to communicate to them that there is a tremendous spectrum of aggressiveness when it comes to prostate cancer. Framing these decisions even before the diagnosis is made is something that I have found to be valuable. I know that many of my colleagues at Vanderbilt also do this so that patients aren't surprised after they're diagnosed with a Gleason 6 tumor with a PSA of 4.2. They should think about an expected management strategy, if for no other reason than to optimize their function for as much time as possible.

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