Many with early prostate cancer may get questionable treatment

More than a third of men with early-stage prostate cancer received treatment that didn’t fit their pre-existing problems with urinary, bowel or sexual function, Boston researchers report in a new study. They said their finding points to poor communication between doctors and patients.

“We found that the mismatches were more common than we figured,” Dr. James A. Talcott of Massachusetts General Hospital said in an interview. “For a single strong contraindication, one-third of patients ended up getting what appeared to be the wrong treatment.”

Men who are diagnosed with early prostate cancer face difficult decisions about treatments. Surgery, radiation and radioactive seeds implanted in the prostate gland all have strengths and weaknesses, but there are few data showing which treatment is better than another in this stage of the disease.

A tie-breaker can be side effects that make urinary, bowel or sexual problems worse. One would expect men who have these problems to be steered away from therapies that are known to offer no benefit or to harm them.

That wasn’t the case for many men in the study conducted at four Massachusetts hospitals. In an article appearing online today in advance of the January issue of Cancer, the authors write that more than a third of men who answered questionnaires were mismatched to therapies.

The researchers, who are also from the Harvard Radiation Oncology Program, the Veterans Hospital in Bedford, Boston University School of Public Health, Dana-Farber Cancer Institute and Harvard Medical School, gave questionnaires to 438 men with early prostate cancer at Mass. General, Dana-Farber, Beth Israel Deaconess Medical Center and MetroWest Medical Center. Almost 90 percent reported problems with urinary, bowel or sexual function before they started treatment. Followed for three years, they were asked about their treatments and their function afterward.

The authors don't say why these mismatches occurred, recommending further research, but they suggest incomplete patient-doctor communication may be to blame. Patients might be embarrassed to tell their doctors about their problems or simply too scared of their diagnosis, Talcott said.

“These are not easy things to talk about,” he said. “Patients will tell things to a questionnaire and a computer that they won’t tell to people, particularly their treating physician.”

Talcott, a medical outcomes researcher who also sees patients as a genitourinary oncologist, said he and his colleagues are trying to figure out what information patients need to make a difficult decision.

“You’d like to prevent death from prostate cancer, but if the price of admission is 20 years of impotence or maybe some urinary incontinence or bowel problems, those are hard decisions,” he said.

Physicians need to consider whether they're getting all the information they need from patients to make a recommendation for treatment -- or for watchful waiting, which was the choice in a small percentage of the study's patients.

The study has value not only in showing how questionnaires can help, but also in revealing that medical care didn’t work as it was supposed to, he said.

“Without that kind of feedback, we really can’t improve,” he said.