I came across a very illuminating study titled “Physician Recommendations Trump Patient Preferences in Prostate Cancer Decisions.”[i] The researchers polled 257 newly diagnosed low-to-intermediate risk PCa patients after diagnosis but before their next urology consultation. The patients answered questions about their preferences in the following areas:
- Treatment preference
- Interest in sex
- Cancer-related anxiety.
The study’s authors used these factors as well as physician treatment recommendation to analyze which might be predictive of treatment choice. On top of that, they recorded the doctors’ clinical encounters with the patients prior to the patients making a decision in order to learn if the doctors discussed patients’ interest in sex. Then, the patients were followed until they eventually decided to have a treatment or go on active surveillance. Their choices were correlated with all factors and analyzed.
What do you think the authors found? Doctor recommendations, not patient preferences, primarily predicted the choice of treatment vs. surveillance. Not surprisingly, the recommendations were based on clinical factors (age and Gleason score). Sadly, physician suggestions were largely disconnected from patients’ “personal views of the relative pros and cons of treatment alternatives.” Based on the taped clinical consultation, the authors concluded, “Urologists rarely discussed patients’ interest in sex (<15% of appointments).”
This situation, documented by research, is worlds apart from our own experience. Granted, patients who come to us for multiparametric MRI and focal laser ablation (FLA) are not representative of all prostate cancer patients. They aren’t waiting for a doctor to bring up treatment-related sexual side effects because sexuality is already a factor in their treatment decision. They come to us because their desire to maintain sexual quality of life led them to seek an alternative outside of the conventional whole gland options, surgery and radiation. They also prefer immediate – and likely durable – tumor control over active surveillance with its uncertainty.
Even with all these up front preferences, we still discuss and evaluate their baseline sexual function. It’s an essential part of the conversation as we work with each patient’s treatment plan. For men who are qualified candidates for FLA, we (and they) have an extremely high degree of confidence that our real-time MRI guided treatment will preserve their potency. So let’s talk about maintaining sexual function after treatment. It’s part of the discussion, it’s part of the planning, and it’s part of the results.
[i] Scherr KA, Fagerlin A, Hofer T, Scherer LD et al. Physician recommendations trump patient preferences in prostate cancer decisions. Med Decis Making. 2016 Aug 10. pii: 0272989X16662841. [Epub ahead of print]