What patients want at prostate cancer diagnosis
1. Give the diagnosis in person
Being diagnosed with prostate cancer can be a big shock and disorientates many men and their families. A diagnosis should always be given in person by the treating specialist who should be friendly, open and sympathetic to the man’s new situation.
2. Guide each man to information relevant to his situation
While some men may want extensive details on their diagnosis, others don’t want any at all. The treating specialist should guide each man (and his spouse, partner or carer where possible) to information relevant to the individual situation. The treating specialist should also initiate discussion and explain treatment options and potential outcomes to help the patient select the most appropriate treatment. As the principal consultant for the patient’s condition, the treating specialist has the responsibility to be patient and ensure the thoroughness of this process.
3. Consider a list of issues and decisions
A list of issues and decisions that will need to be considered should be given to each patient. For some of these matters the treating specialist should give authoritative advice and recommendations, while for the others it is appropriate to guide the patient to seek further information and advice.
Some key components of this list should include:
- General information on prostate cancer
- Treatment or intervention versus active surveillance - issues and likely outcomes
- Available treatment options, such as surgery and/or radiation, and the types of each
- Side effects of treatments, including short and long term risks of incontinence and impotence and rectification options for these
- Risk of short or long term recurrence of cancer after initial treatment and management options if this occurs
- Other health professionals that may assist in the treatment process of prostate cancer, such as radiation oncologists for radiation treatment, physiotherapists or continence nurses for pelvic floor exercises
- Availability of peer support group networks and where to find them. When applicable, the patient or the patient's carer should be given details of the local support group
- The value of a support network and the involvement of a spouse, partner or carer throughout the cancer journey, starting with initial cancer management decisions
- The option to obtain a second opinion from another health professional to assist the decision process
- The experience history in treating prostate cancer of the treating specialist
- Recommended treatment for the individual patient and the reasoning for this recommendation
- An estimate of treatment timings and costs and explanation of issues around public versus private treatment
- Awareness of patients with different needs, for example patients from rural, regional and remote areas, men with religious, cultural and language differences, gay and bisexual men.
4. Help the patient through the decision process
An important point to remember is that most patients have no experience with cancer or its treatment process. The diagnosing specialist has a special responsibility to help the patient find a decision process that will provide sustained comfort, both leading to a treatment decision and retrospectively when the agreed treatment has been completed.