Prostate cancer represents the most common neoplasm and second leading cause
of cancer mortality among men in the United States. There are 189,000 new cases
of prostate cancer and 32,000 deaths resulting from prostate cancer expected in
There is no particular prostate cancer treatment that is clearly superior
with respect to survival. As a result, patients and physicians should consider
the quality of life implications of each treatment during the decision-making
Previous studies have suggested that physicians may experience difficulty
incorporating patient preferences into clinical decisions.
First, physicians and patients may have different ideas with respect to the
goals of treatment. Crawford found that patients rated preservation of quality
of life (45%) and extension of life (29%) as the most important treatment
goals, while urologists cited treatment efficacy (85%) as the primary
consideration in decision-making, ranking quality of life concerns as
secondary. In the context of patient-physician communication, Miles found
that a majority of patients did not recall discussions with their treating
physicians about issues such as expectant management, patient preferences, and
treatment-related side effects.
These studies suggest that physician understanding of patient concerns and
patient participation in the decision-making process should be addressed.
Works in Progress
Although patient involvement in the treatment decision-making process has
been encouraged, shared decision-making between patients and their physicians
and the programs used to increase patient participation remain works in
progress. A wide variety of shared decision-making programs, including videos,
brochures, and CD-ROMs, have been developed to provide patients with
information about prostate cancer and the risks and benefits associated with
each treatment option.
1. American Cancer Society: Facts and Figures 2002. Atlanta, Georgia,
American Cancer Society, Inc., 2002.
2. Crawford DE, Bennett CL, Nelson NS, et al: Comparison of perspectives on
prostate cancer: Analysis of survey data. Urology 50:366-372, 1997.
3. Miles BJ, Giesler B, Kattan MW: Recall and attitudes in patients with
prostate cancer. Urology 53:169-174, 1999.
4. Wagner EH, Barrett P, Barry MK, et al: The effects of shared
decision-making program on rates of surgery for benign prostatic hyperplasia:
Pilot results. Med Care 33:765-770, 1995.
5. Barry MJ, Fowler FJ, Mulley AG, et al: Patient reaction to a program
designed to facilitate participation in treatment decisions for benign
prostatic hyperplasia. Med Care 33:771-782, 1995.
6. Bennett CL, Ferreira MR, Davis TC, et al: Relation between literacy,
race, and stage of presentation among low-income patients with prostate cancer.
J Clin Oncol 16:3101-3104, 1998.
7. Kim SP, Bennett CL, Chan C, et al: QOL outcomes research in prostate
cancer patients with low socioeconomic status. Oncology 13:823-832, 1999.
8. Kirsch I, Jungeblut A, Jenkins L, et al: Adult literacy in America: A
first look at the results of the National Adult Literacy Survey. Washington,
DC, National Center for Education Statistics, U.S. Department of Education,
9. Ad Hoc Committee on Health Literacy for the Council on Scientific
Affairs, American Medical Association: Health literacy: Report of the Council
on Scientific Affairs. JAMA 281:552-557, 1999.
10. Schapira MM, Meade C, Nattinger AB: Enhanced decision-making: The use of
a videotape decision aid for patients with prostate cancer. Patient Education
and Counseling 30:119-127, 1997.
Mr. Nathan and Ms. Newlin are project managers, Northwestern
University Medical School. Dr. Bennett is professor of medicine, Northwestern
University Medical School, Robert H. Lurie Comprehensive Cancer Center, and
director of HSR&D, VA Chicago Health Care SystemLakeside Division.