A Patient-Centered Look at Prostate Cancer
For the past few months, the COVID-19 pandemic has dominated the news cycle—especially coverage of health. But as big an issue as COVID is, it’s not the only disease we have to worry about. Heart disease, cancer, and diabetes are still significant causes of disability and death and will continue to be long after the COVID crisis has passed. And for men in particular, there’s one more serious illness that we shouldn’t overlook: Prostate cancer. Every year, nearly 200,000 men are diagnosed with the disease and more than 33,000 will die.
While public and private spending on female-specific cancers dwarfs spending on male-specific cancers, one organization, the Patient-Centered Outcomes Research Institute (PCORI—a U.S.-based non-profit created through the 2010 Patient Protection and Affordable Care Act) has funded a number of important prostate-cancer studies designed to “help patients and those who care for them make better-informed healthcare decisions.” Let’s take a look at a few of them.
- “Helping Men with Prostate Cancer Determine Their Preferences for Treatment.” This 2019 study, published in the Journal of Clinical Oncology, provided an overview of the major treatment options for men with localized prostate cancer (meaning that it hasn’t spread to other areas of the body). These include: surgery (to remove the prostate gland), radiation (to destroy cancerous tissue in the prostate), and active surveillance (frequent monitoring by a doctor to ensure that the cancer isn’t progressing and/or spreading). To help patients and their healthcare providers assess the risks, benefits, and possible side effects of each treatment option, the researchers developed a web-based intervention called PreProCare. They then compared a group of patients who used PreProCare with a control group that didn’t. Compared to the control group, those who used the intervention were: more satisfied with their care and choice of treatment; more likely to choose active surveillance if they were at low risk of the cancer spreading; less likely to have severe urologic problems; able to get back to daily physical tasks sooner; less likely to have high levels of depression.
- “Comparing the Effects of Surgery, Radiation Therapy, and Active Surveillance on Men with Localized Prostate Cancer—The CEASAR Study.” This 2019 study of 2,550 men with localized prostate cancer, published by PCORI, examined the three treatment options discussed above, with a focus on sexual function, urinary issues, and bowel problems in the three years after treatment. The researchers found that, “men who had surgery reported lower sexual function than the men who had radiation or active surveillance. Men who had radiation and those who had active surveillance reported similar sexual function.” In addition, “[m]en who had surgery reported more leaking of urine than the men who had radiation or active surveillance. Men who had radiation and those who had active surveillance reported similar leaking of urine.” None of the treatment options produced any significant impact on bowel function.
- “Treatment Decision Support for Men with Prostate Cancer and Their Caregivers.” This 2019 study, published by PCORI, compared two groups of men with prostate cancer and their caregivers (usually a partner or spouse). One group used a mobile app (the Personalized Health Information Navigator) that had information about the benefits and risks of various treatment options. The other group received a printed booklet with similar information. Both groups also worked with a community support person who helped explain the content in the app or booklet. The researchers found difference between the app and the booklet in terms of what men and their caregivers learned or how they made their treatment decision. “But in both groups, almost all the men and caregivers reported increased satisfaction with their treatment decisions. At the end of the study, caregivers from both groups knew more about prostate cancer than they did at the start.”
- “Depression and Prostate Cancer: Examining Comorbidity and Male-Specific Symptoms.” This 2018 study, published in the American Journal of Men’s Health, studied the well-documented issue of depression in men with prostate cancer. The researchers found “potential benefits of evaluating male-specific symptoms as part of depression and suicide risk screening in men with prostate cancer and the need to be mindful of the heightened risk for depression among men with prostate cancer who have comorbidity.”
You can find more information on these and many other PCORI-funded studies and projects at https://www.pcori.org/