Although About 1 in 8 men in the US In their lifetime, just one in 44 will die from prostate cancer. Most men diagnosed with prostate cancer die of other causes, especially low-risk prostate cancer that sometimes grows so slowly that it is just not life-threatening.
nevertheless, Until about a decade ago, most men diagnosed with low-risk prostate cancer are immediately treated with surgery or radiation. Although each can treat cancer, they may have serious, life-changing complications, including urinary incontinence and erectile dysfunction.
I'm a Family physician and researcher To study how patient-physician relationships and decision-making processes influence prostate cancer screening and treatment. In our recently published research, my colleagues and I discovered that men are growing faster. Opting against urgent treatment. Instead, they're choosing a more conservative approach often known as lively surveillance: keeping a detailed eye on the cancer and continuing treatment until there are signs of progression.
Problems with prostate cancer screening
Prostate cancer screening is controversial since it often results in overdiagnosis and overtreatment of cancers that will otherwise be harmless had they gone undetected and untreated.
Prostate cancer screening normally uses a blood test that measures the extent of a protein produced by prostate cells. Prostate-specific antigen, or PSA. An elevated PSA level can indicate the presence of prostate cancer, but not all cases are aggressive or life-threatening. And PSA levels can rise for reasons apart from prostate cancer, corresponding to an enlarged prostate gland on account of aging.
Because of widespread PSA screening within the United States, More than half of prostate cancers Screening found low risk. Concerns about overdiagnosis and overtreatment of low-risk cancers are the major explanation why screening is just not really useful unless patients need to be screened after discussing the professionals and cons with their doctor.
What is lively monitoring?
Active monitoring A secure and effective solution to manage low-risk prostate cancer is to limit treatments corresponding to surgery or radiation to only those cancers which are growing or becoming more aggressive. This includes monitoring the tumor through regular check-ups and tests.
Active surveillance is different from “Watchful waiting“Another conservative strategy is a less intensive style of follow-up that involves fewer tests and only addresses symptoms. In contrast, lively surveillance involves more intensive monitoring, including treatment when needed. The intention to achieve this involves more tests to maintain a detailed eye on the cancer.
Active monitoring allows patients to delay or avoid invasive treatments and their associated uncomfortable side effects. The goal is to balance keeping a detailed eye on cancer while avoiding treatments unless they're really needed.
All leading medical groups Recommend active surveillance As a preferred approach to look after men diagnosed with low-risk prostate cancer. Recently, nevertheless, the variety of patients selecting lively surveillance within the US has increased has decreasedFrom lower than 15% in 2010 to just about 40% in 2015. The specific reasons for the underuse of lively surveillance within the United States usually are not well understood.
Facilitators and barriers to lively surveillance
What aspects influence treatment decisions? To answer this query, my team and I surveyed 1,341 white and 347 black men with newly diagnosed low-risk prostate cancer from 2014 to 2017. .
Overall, More than half of men Chose lively surveillance. This was much higher than an analogous study conducted by our team nearly a decade ago, which found that Only 10% men Chose lively surveillance.
Increased lively surveillance is nice news, however it is just not where it is required. The US still lags behind many European countries, corresponding to Sweden, where More than 80 percent of patients Diagnoses with low-risk prostate cancer select lively surveillance.
To discover what motivated patients to decide on lively surveillance, we decided to ask them directly.
Urologist's suggestion had the strongest effect: About 85 percent of patients Those who selected lively surveillance reported that their urologist really useful it. Other aspects include a shared treatment decision with the patient's physician and greater knowledge about prostate cancer. Interestingly, participants living in metro Detroit were more prone to select lively surveillance than those living in Georgia.
In contrast, there have been men. Less likely to try. Active surveillance in the event that they have a powerful desire to receive treatment, expect to live longer with treatment or have a more serious diagnosis of low-risk cancer. About three-quarters of patients who select immediate treatment expect to live not less than five years as they'd without treatment, which is unrealistic and Not based on current evidence..
Misconceptions, unrealistic treatment expectations and biases can lead patients to decide on unnecessarily aggressive treatment, risking its harm without survival profit and potentially regretting their decision later. Is.
Ethnic and geographic differences
We also found racial and geographic differences in the speed of adoption of lively surveillance.
on average, Black patients were at higher risk. of developing and dying from prostate cancer compared with white patients. Furthermore, because the information supporting the usage of lively surveillance are based totally on white men, the risks and advantages of lively surveillance in black patients are more controversial. In fact, our study found that 51 percent of black patients selected lively surveillance compared with 61 percent of white patients.
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Specifically, black men reported receiving less lively surveillance recommendations from urologists and were less engaged in shared decision-making with their physicians than white men. This racial difference in lively surveillance rates was now not significant after accounting for urologist recommendations, decision-making style, and other aspects.
But Geographical differences Consistent: Patients living in Detroit were more prone to undergo lively surveillance than those living in Georgia. This likely reflects the inner care patterns of some urologists. Some studies have found that Now a urologist was in practice.the less likely they're to recommend lively surveillance to their patients.
Encouraging lively surveillance
Our findings are encouraging in that they show that lively surveillance has develop into more acceptable to each patients and urologists over the past decade. However, our results also suggest that greater physician engagement and higher patient education may support the adoption of lively surveillance.
For example, when doctors appropriately describe low-risk prostate cancer as small or aggressive, combined with a positive prognosis, this could give patients a way of relief. Alternate patients Feel more comfortable With lively monitoring.
Conversely, a patient's misunderstanding of how serious their cancer is can result in unnecessary treatment. Clinicians reassure patients that lively surveillance is a secure and preferable alternative. They may explain that aggressive treatment Don't improve survival For most low-risk patients and may cause significant long-term uncomfortable side effects.
More shared treatment decision-making involving patients and their physicians may improve the likelihood of selecting lively surveillance in comparison with patients who make decisions on their very own.