Helping patients make informed decisions about prostate cancer

Morgan Liotta

30/07/2019 4:42:12 PM

GPs have a central role in facilitating informed decision making for prostate cancer patients’ treatment options, an expert says.

GPs help patients make informed decisions.
Rapid and ongoing advances in prostate cancer treatment options means it is important for GPs to remain up to date in their knowledge.

‘The best way we, as GPs, can support men with newly diagnosed prostate cancer is to make sure they are fully informed about their treatment options,’ Dr Martine Walker, RACGP examiner and a GP with a special interest in prostate cancer, told newsGP.
‘Patients listen to GPs and value our opinions.’
With rapid advances in prostate cancer treatment, Dr Walker emphasises that GPs remain up-to-date with the latest options to provide appropriate advice and support their patients in this important decision.
‘Advances in treatment mean many of the complications we saw in the past are now rare,’ she said.
‘Because the management of prostate cancer straddles a number of specialties, it is often difficult to get a sense of how the different treatments compare. More education in a multidisciplinary format would be helpful for GPs to compare and contrast treatments.’
Dr Walker says it is also important that prostate cancer patients have the opportunity to speak in person with both a radiation oncologist and urologist before they make their treatment decisions, to avoid ‘decisional regret’.
‘No matter how well educated GPs are about prostate cancer treatment we cannot be expected to know the minutiae of the numerous surgical and radiation therapy alternatives for treatment … [but part of our role is to] ensure patients are fully informed,’ she said.

Dr-Martine-Walker-article-1.jpgDr Martine Walker believes that GPs are central in aiding patients to make informed decisions about prostate cancer treatment options.

Specialties involved in treating prostate cancer – radiation oncology and urology – are two very different areas, both of which are evolving quickly, according to Dr Walker.
‘Both radiation therapy and surgery have different potential side effects, logistics and costs. Each man will have different priorities for treatment and their post-prostate cancer life,’ she said.
‘Radiation therapy and surgery are equally effective in curing and controlling prostate cancer, and most men who need active treatment could be suitable for either.’
When referring to a specialist (urologist) to investigate possible prostate cancer, Dr Walker recommends GPs advise the diagnosing specialist that they expect the patient will have the opportunity to speak to a radiation oncologist before any definitive treatments are decided on, if the patient receives a diagnosis of prostate cancer.
‘The best way GPs can support men to make informed decisions about their prostate cancer treatment is for the GP to “front load” the referral process,’ she said.
Dr Walker advises GPs that before referring their patients, to inform them that: 

  • the two main treatments for prostate cancer are radiation therapy (external beam or brachytherapy) or surgery
  • both treatments are equal in terms of freedom from cancer at 10 years and beyond
  • before making a decision about treatment, the patient should have the chance to consult in person with both a radiation oncologist and a urologist
  • if the urologist does not arrange an appointment with a radiation oncologist, that you (the GP) will be happy to arrange the appointment
  • there is no benefit in rushing into treatment. 
The Royal Australian and New Zealand College of Radiologists also highlights that there is ‘rarely a need to proceed to treatment very quickly’, and Dr Walker acknowledges this time for a man and his family to seek the information they need without being rushed into treatment, in nearly all cases, even ‘aggressive’ prostate cancers.
‘It is important men are given all the time and information they need to make decisions that are best for them,’ she said.

men's health prostate cancer prostate cancer treatment options radiation therapy

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Angels   31/07/2019 7:07:32 AM

I practice in a regional area where there is a very enthusiastic urologist especially for privately insured patients and even when I do tell the patient there are options other than surgery and that an opinion should be sought from a radiation specialist, I don't see them again until after their surgery! Patients are anxious and want treatment as quickly as possible. if radiation oncologists provided a visiting service or even Tele health services it would be more conducive for patients to get their opinion. Unfortunately patients have to see the urologist for a biopsy before there is confirmation of diagnosis.

Prof Max Kamien, AM   31/07/2019 10:54:46 AM

All good advice. But if you are a 'second class' patient you may not have a choice of treatment. A pensioner friend was most insistent that he wanted surgery and not radiotherapy. He was told that the big new hospital policy was for radiotherapy. He has developed severe radiation colitis with frequent massive bleeds. He sure suffers from 'decision regret' and is in limbo with no single doctor as his advocate. Sadly, we do have a two-class health system.

Rick H   31/07/2019 12:29:08 PM

Dr Walker advises that both treatments (radiotherapy and surgery) have the same outcomes at 10 years and beyond.
However, not having either treatment (i.e. having no active treatment) has been demonstrated in multiple trials to have similar outcomes and I wonder why this was not suggested as an alternative.
No treatment also avoids the many potential distressing side effects of radiotherapy/surgery.

Michael F   31/07/2019 8:49:01 PM

Rick, devil is in the detail. That study you refer to had mostly low grade cancers, the vast majority of whom would be managed conservatively if treated today. Additionally, 10 years is not long enough to make a proper assessment of mortality benefit.

George   31/07/2019 8:53:32 PM

Three red flags to get a second opinion:-
1. If a surgeon states that the surgery is urgent and needs to be done next week,
2. If a surgeon tells you it suggests to you that they are the best trained or most experienced
3. The cost for surgery is over 10K

Rick H   1/08/2019 2:04:20 PM

Michael, may I refer you to a study published in the NEJM July 2017 ; "Follow up of Prostatectomy versus Observation for Early Prostate Cancer" that followed men for approx 20yrs. Surgery was not associated with significantly lower all-cause or prostate-cancer mortality than observation.
You agree that the majority of low grade cancers don't need active treatment. However, if active treatment of high grade cancers improved mortality, it should be very obvious in the trial outcomes.

Jenny P.   3/08/2019 8:32:41 AM

Michael F, and that's why all the flag-waving about '5-year survival rate' by the cancer industry and public health bureaucrats is b.s.