A promising trend in prostate cancer (PCa) treatment is shared decision-making between doctor and patient. Tailoring treatment today is more complex due to a number of factors:

• A wide array of treatment technologies and methods (surgery, radiation, ablation)
• Understanding how gene mutations impact the biology of different PCa cell lines
• Improved diagnostics such as multiparametric MRI and biomarkers allowing earlier detection, treatment planning, and post-treatment monitoring
• Accumulation of data from patient reports on how treatment side effects diminish long term quality of life.

I want to particularly focus on that last point about patient reports. A recent (June 2025) published paper discusses patient reported outcomes (PROs) as a critical element in choosing a PCa treatment.^[i] The authors note, “Each treatment modality presents distinct risks, notably urinary incontinence, erectile dysfunction, bowel issues, and cancer recurrence.” A doctor is responsible to know the technical details and cancer control rates of each treatment option, particularly the method(s) in which the doctor specializes.

In addition, the doctor’s ongoing clinical education should include familiarity with PROs. Learning what patients report is not difficult, since researchers continually publish their findings from follow-up studies that track quality-of-life aftereffects: post-treatment incidence and duration of incontinence, erectile dysfunction, bowel problems, etc. These days, patient interviews and questionnaires include not only statistics, but also descriptions of their personal experience (impact on emotions, self-image, relationships, etc.)

Thus, journals and professional meetings give doctors access to a wealth of information on the personal aftermath of each PCa treatment. In turn, this enriches the role of a doctor not only as healer but also as an empathic counselor who gets to know what personally matters to each patient in addition to destroying his cancer.

Just as important, the paper “advocates for personalized, evidence-based management strategies that align therapeutic decisions with individual patient preferences, optimizing both survival and quality of life.” In other words, what do you care about in your lifestyle?

What matters to you?

At the risk of oversimplifying the not-so-distant past, PCa treatment guidelines were biased toward surgery as having the longest survival rates (called “the gold standard”), or radiation for patients who couldn’t have or didn’t want surgery. Doctors told patients about side effect risks, and patients accepted them as a trade-off for not dying of PCa. Yet many men’s post-treatment lifestyles were altered as they had to cope with wearing pads or diapers, using vacuum devices or injections to have sex (or giving up on sex altogether), and having embarrassing bowel problems. It’s no wonder, then, that the advent of focal ablation therapies like our Focal Laser Ablation presented new options for excellent cancer control with minimal side effect risks. The ability to destroy a PCa tumor using minimally invasive heat, cold, or electric current was a welcome alternative to whole gland treatment for carefully qualified patients.

It thus falls on the doctor’s shoulders to become acquainted not only with data on cancer control and side effect risks of each treatment, but what patients describe months and years after each treatment. In the words of the article, “Presenting patients with comprehensive data allows them to reach their own personal conclusions about the relevance of each the reported outcomes and reduce decisional regret due to insufficient understanding of treatment adverse effects.” This means taking personal time to read journals and attend conferences. It also means taking clinic time for sensitive discussions about each patient’s life circumstances, relationships, and preferences. If the patient is in a committed relationship, including the partner in these sessions recognizes that PCa is a couple’s disease, with an aftermath affecting both members.

No two PCa cases are alike. Patient age, co-existing health concerns, extent and aggression level of the tumor, etc. will influence treatment method. Patients with early stage, low risk disease have a wide range of therapy options with roughly equal success rates. A knowledgeable doctor will advise each patient according to such factors, and be honest in sharing what patients themselves have reported about their post-treatment side effects as described in published studies like the ProtecT trial. In addition, the doctor and patient must take lifestyle into account when tailoring the choice to the patient. The shared discussion process should illuminate the decisional pathway. “By properly educating patients so they can make informed decisions about their health, physicians can maximize patient autonomy and minimize regret,” say the authors.

The Sperling Prostate Center embraces the principle of shared decision-making. Let us know what matters most to you so we can work together in customizing your treatment plan.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Nguyen T, Lightfoot C, May D, Greenberg JW, Krane LS. Patient Reported Outcomes and Treatment-
Associated Complications as a Consideration in Selecting Localized Prostate Cancer Management. Res Rep Urol. 2025 Jun 12;17:195-210.