I wholeheartedly agree with the sentiments expressed in the article Prostate Cancer: Men Deserve Better, European Association of Urology, March 17, 2009 (exerpts below). . But talk is cheap. The question is, how do we bring about real change (change we can believe in!)? That’s a lot to ask — but heck, we are worth it. We also need a system in which newly diagnosed PC patients are seen by a multidisciplinary team of doctors, consisting perhaps of a urologist, radiation oncologist and medical oncologist. Fortunately, we have such a model now. I received this article a few weeks ago about a new, “patient-centered” unit at UCLA: “Urologic Oncology Institute Launched To Offer Multi-Disciplinary Care, Personalized Treatments To Patients” (March 04, 2009). https://mail.google.com/mail/?source=navclient#search/multi/11fdd1625aa370e2

In this case, a group of urologists (and patients) are pointing out some shortcomings of current PC management, such as a lack of communication between doctor and patient. In order to truly give consent to a treatment such as surgery or radiotherapy, I believe a patient must have been informed of the risks and benefits of all the reasonably accepted treatments available.

The burden is on the urologist to do this, because these doctors are almost always the “first stop” (and usually only stop) for newly diagnosed PC patients. There is an issue of time here, as the doctor can’t spend the whole day discussing PC with the patient, but one advocate has suggested that urologists provide patients with written materials about PC that they then could use for discussion. I think this is a good idea.

Also, the authors lament the poor quality of life that can ensue after prostate cancer treatment. But the comparison with breast cancer treatment is not a good one. Women who are treated for BC may have a better quality of life than men treated for PC for an obvious reason — their urinary and sexual functions have not been interfered with.

What we need is new treatments, applied sparingly, with fewer side effects.

Finally, I want to add a word about two neglected areas in PC treatment. We need to do more to diagnose and treat mood disorders and other psychological issues which may occur in PC patients. Second, we need to draw in a spouse or significant other (if there is one) into the discussion of PC options, and also monitor the partner’s well-being over time.

“Prostate Cancer: Men Deserve Better”

    “Vast improvements in prostate cancer recognition, management and treatment are needed, according to major prostate cancer groups speaking at the European Association of Urology’s 24th Annual Congress today.

    “… The group’s overarching concern is a lack of clear and consistent information, particularly in areas that affect a man’s quality of life and that of his family. Prostate cancer and its treatments impact on all elements of a man’s life and not just his physical being. Many men experience urinary incontinence and impotence which can severely compromise their sense of masculinity and day-to-day quality of life, affecting their work, social activity and love life. The charter asks for practices to be put into place to better inform and educate men, their families and all those involved in prostate cancer care of the far-reaching effects of the disease and to encourage a more open, communicative and holistic approach to its treatment and management.

    “Tom Hudson, Chairman of Europa Uomo, explains, ‘Our charter highlights the shortcomings in the current management of men with this condition but from a very practical viewpoint. For example, maintaining key relationships, love life and intimacy throughout prostate cancer is incredibly important but can often be overlooked. Many men feel uncomfortable discussing these issues and avoid them altogether. It is an area which is absolutely key to men’s quality of life and there needs to be a cultural shift in the way it is approached and managed’.

    “Louis Denis, Secretary of Europa Uomo, adds “There is still much room for improvement in the management of prostate cancer and the fight against the disease is far from over. Prostate cancer does not receive anywhere near the level of interest and funding it warrants and this must be addressed. With the right holistic approach, men diagnosed with prostate cancer can live long and fulfilled lives. This approach has been taken very successfully to women with breast cancer and we believe that men deserve to be treated in the same way. At the moment, quality of life for men with prostate cancer can be very low, and steps must be taken to recognise and treat the whole person behind the disease, not just the disease itself.”