Prostate Cancer: New Help for Tough Choices

Original article Prostate Cancer: New Help for Tough Choices

April 25, 2001 (Dana Point, Calif.) — It’s now clear that nearly half of all U.S. men one day will hear the dread news that they have prostate cancer. What’s unclear is what they should do about it.

New tools can help men make this difficult decision, according to experts gathered here at the American Cancer Society’s Science Writers Seminar.

“For men today diagnosed with prostate cancer, 90% have localized, early cancer,” says Peter Scardino, MD, of Memorial Sloan-Kettering Cancer Center in New York. “The dilemma they face is, ‘What shall I do about this? Should I treat it at all — or is the word cancer scaring me into taking potentially dangerous treatments?’ It is an agonizing decision among a wide array of different types of treatments. The better we understand the consequences of these choices, the more we can help men make wise decisions they can live with.”

Three conference presentations show that much progress is being made:

• Michael Kattan, PhD, outcome research scientist at Memorial Sloan-Kettering, has developed a computer-based tool called a nomogram. The program takes in a man’s personal and medical data and then tells him — in cold, hard numbers — what his chances are for success and side effects with each available treatment.
• Mark S. Litwin, MD, MPH, associate professor of urology and health services at the UCLA Jonsson Cancer Center, has gathered data on the quality of life for patients who have undergone various treatments for prostate cancer. These findings can be used by new patients to make informed treatment choices.
• Joseph J. Disa, MD, a reconstructive and plastic surgeon at Memorial Sloan-Kettering, has helped to develop a new nerve-grafting technique that greatly reduces two of the most feared consequences of prostate surgery: erectile dysfunction and urinary incontinence.

What Are My Chances, Doc?

When a patient first learns he has prostate cancer, he is faced with a bewildering array of options:

• Surgery can cut away the tumor — and maybe also the nerves that control erections and urination.
• External-beam radiation can kill prostate cancer cells, but the treatment can cause painful bladder symptoms and other problems.
• Brachytherapy is the implanting of small, radioactive seeds into the prostate, where they kill cancer cells — but new studies suggest that this treatment may have the same drawbacks as external radiation.
• And then there is watchful waiting, based on statistics that show a man is more likely to die with prostate cancer than to die of it. But for many patients — especially Americans with their can-do attitude — living with cancer is hard to accept.

Now Kattan and colleagues have developed the nomogram, a new program that lets a doctor punch in all relevant medical details into a computer or handheld device. Then, at the press of a button, the program shows what the chances are that a particular treatment will work for a particular patient — and what the chances are for something to go wrong.

“This approach is attempting to maximize the accuracy with which you can do that,” Kattan says. “The nomogram generally predicts better than a doctor’s prediction. … When it comes down to predicting, we as humans tend to predict the outcome we want to happen, not the outcome most likely to happen.”

A new, recently completed study of more than 4,000 patient records showed that the nomogram’s predictions come amazingly close to actual patient outcomes.

“I think what the nomograms will help do is put a number on the likelihood of success with different treatments,” Scardino says. “But it will not show whether one treatment is better than another. It will show that a certain treatment may be more likely to help, and then the decision will be whether the potential side effects are worth it.”

Litwin and Scardino already use the program in clinical practice. “My patients love it — even the ones that get bad news,” says Litwin.

female impotence, and more another.