The Exchange

Commentary and Observations from
the Medical Front Lines

Prostate Cancer and Shared Decision-Making

Prostate Cancer and Shared Decision-Making

All men are at risk for prostate cancer and one out of nine will develop the disease; age and family history influence the chance of a man developing prostate cancer. However, not all men diagnosed with prostate cancer require treatment.

The use of shared decision-making can be valuable in every aspect of a man's prostate evaluation. It can create a partnership between patient and provider, allowing patients to be more involved in every step of their care—from the decisions for screening, testing, and referral to urology to the discussion of pros and cons of further assessment. This approach can be valuable in helping patients understand and compare the choices available to them. Additionally, understanding patient goals can allow a provider to better explain options and guide treatment selection. Often patients would prefer the provider to weigh in on a decision, asking questions such as: "Should I have a biopsy? Should I have a repeat blood test? Should I choose radiation or surgery? Should I begin hormone deprivation therapy or chemotherapy? Tell me what I should choose."

Helping patients understand the potential side effects of diagnostics can help them make informed decisions in the early stages of diagnosis—including whether or not to have a prostate biopsy. If the patient has known prostate cancer by biopsy, their next steps are to consider treatment versus active surveillance. Many factors influence patient choices, including their overall level of risk based on the aggressive nature of the prostate cancer, their overall health and life expectancy, and whether or not they want to be treated or followed closely with active surveillance. Using shared decision-making continues to be important as the patient undergoes a lifetime of care.

Many men can live with prostate cancer that is a low-grade, nonaggressive type for years—even decades—without treatment. Helping patients understand how to keep their treatment choices open while being followed is an important aspect of care. For men with treated, recurrent, or metastatic prostate cancer, shared decision-making is important because of the many options that are available. For men with recurrent prostate cancer that has not metastasized, the goal of metastases-free survival is considered an important endpoint. Therefore, again, the role of active surveillance and assessment, as well as treatment choices along with therapeutic pros, cons, and potential adverse effects is important to go over.

As patients with prostate cancer live longer, their choices can become more complex. Understanding these options is important so they can feel comfortable with the path they choose. The goal of active surveillance in prostate cancer patients who have not yet been treated is to maintain or improve their quality of life; though they may ultimately need treatment, avoiding treatment side effects while being actively monitored can lead to a better quality of life. Patients with metastatic prostate cancer also have multiple options for treatment and need to understand the pros and cons of each, along with the side effect profiles, so they can weigh it against their current quality of life.

Advanced practice providers (APPs) often have the unique opportunity to develop long-term relationships with their patients and guide them through shared decision-making as they address their prostate cancer. In many practices, the APP has more time to spend with patients and their family/caregivers, during which they can use shared decision-making to address treatment plans. This can be invaluable in the life of a man deciding about prostate cancer care.

There are many resources available to help explain diagnosis, treatment, and cancer management to your patients: Us Too has a page dedicated to providing treatment explanations to patients with prostate cancer, as well as a page of tips for those who are recently diagnosed with prostate cancer. Additionally, the National Comprehensive Cancer Network has detailed information for both patients and clinicians regarding prostate cancer.

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