The accuracy of patients’ perceptions of the risks associated with localised prostate cancer treatments
Results
About two-thirds (68%, n = 211) of the patients did not understand that the risk of disease recurrence is comparable between RP and RT.
More than half of the patients did not comprehend that RP patients are at greater risk of urinary incontinence (65%, n = 202) and erectile dysfunction (61%, n = 190), and less at risk of bowel problems (53%, n = 211) compared to RT patients.
Many patients overestimated the risk of requiring definitive treatment following AS (45%, n = 157) and did not understand that mortality rates following AS, RP, and RT are comparable (80%, n = 333).
Consulting a radiotherapist or a clinical nurse specialist was positively associated with, and emotional distress was negatively associated with, better understanding of the risks (P<0.05), although effect sizes were small.
Conclusion
Prior to choosing treatment, most patients with prostate cancer poorly understood the differences in treatment risks.Greater efforts should be made to better understand why these misperceptions occur and, most importantly, how they can be corrected.
I did my research, and I new the risks of treatments, but I accepted them to live. I have two adverse side effects that impact my QOL. However, I have learned to live with them. I have no regrets.
I have always felt the the treatment decision is as much an emotional decision as it is a medical decision. I had several opinions from different docs, did a lot of research, and talked to several docs and patients.
After understanding the treatment options/side affects and outcomes I folded in my personal feelings about QOL and made my decision on treatment. I have no regrets.
If the conclusion is true that RP and RT have the same chances of success, then I think it's likely that the best course of action may be to pick the best doctor you can find. A great surgeon would be preferable to an average radiation oncologist, and a great rad onc would be preferable to an average surgeon.
If they’ve treated many many prostate cancer patients , have a great pedigree, have published and are or have been associated with a great cancer institution they’re great.
As GeoffAS says below, experience is a big differentiator, though it's not always easy to find out how much experience a doc has.
One thing I also look for is how caring the doctor is. Does he listen when I say something? If I ask a question does he give a thoughtful answer? If the answer is technical does he try to explain it in terms I can understand? Does he take side effects and quality of life issues seriously? Does he ask me questions about symptoms, drug reactions, past history, etc.? Does he allocate a reasonable amount of time for an appointment or does he rush me through to cram in more patients in his day? Does he return phone calls or emails? Does he give me straight answers or does he try to blow me off with BS ("98% of my patients are cured. 95% have no significant side effects.")
The decision is more than just best doc. There are different side affects as well as differing odds on the side affects. Understanding the differences and how they impact QOL is important as well.
As to choosing a doc, it can be difficult to gain information on what good is. Some things you can research is experience. I have seen a couple of studies that indicate a significant difference with experience. They graphed number of surgeries vs biochemical recurrence. It showed a significant reduction at around 250 surgeries.
Robotic surgery is the newest buzz. However it is only as good as the surgeon operating it. Does the surgeon have experience with using the robot? Have they had situations in which the machine failed (very rare but it has failed) and being able to recover?
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