Helping patients with localized prostate cancer reach treatment decisions

Kathryn Birnie; John Robinson

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First do no harm?
Bart J. Harvey

Published on: 16 March 2010
What would YOU do, Doc?
Anne Katz

Published on: 17 February 2010

Published on: (16 March 2010)
Page navigation anchor for First do no harm?
First do no harm?
Bart J. Harvey, Associate Professor & Public Health Liaison
Other Contributors:
While we are very supportive of family physicians’ important role in “helping patients with localized prostate cancer reach treatment decisions,” we feel it is just as important that family doctors attempt to ensure that as few men as possible are made to face this decision. Neither Birnie and Robinson's Clinical Review [1] nor Ladouceur's accompanying editorial [2] appear to address nor acknowledge the fact that one of...
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While we are very supportive of family physicians’ important role in “helping patients with localized prostate cancer reach treatment decisions,” we feel it is just as important that family doctors attempt to ensure that as few men as possible are made to face this decision. Neither Birnie and Robinson's Clinical Review [1] nor Ladouceur's accompanying editorial [2] appear to address nor acknowledge the fact that one of the most effective ways to avoid this clinical dilemma is simply to not use or recommend unproven cancer screening techniques—thus allowing men with asymptomatic localized prostate cancer to remain rightly unidentified.
The clinical scenario at the beginning of Birnie and Robinson's review [1: 137] mentions that the patient was “sent to a urologist because of an elevated prostate-specific antigen and abnormal findings from digital rectal examination.” It is not clear why either of these examinations were carried out given that neither is recommended for asymptomatic men [3]. Is it not possible that had this physician followed current prostate cancer screening recommendations, s/he would have avoided needing to "help this patient with localized prostate cancer reach treatment decisions"? Even more important, this patient could have also avoided being placed in this stressful circumstance!
Bart J. Harvey, MD, PhD, MEd, FACPM, FRCPC Associate Professor and Public Health Liaison Department of Family and Community Medicine
Anthony B. Miller, MD, FRCP, FRCPC, FFPH, FACE Professor and Associate Director, Research Dalla Lana School of Public Health
University of Toronto Toronto, ON M5T 3M7
References
1. Birnie K, Robinson J. Helping patients with localized prostate cancer reach treatment decisions. Can Fam Physician 2010 Feb; 56(2): 137- 41.
2. Ladouceur R. If only we could predict the future! Can Fam Physician 2010 Feb; 56(2): 117-8.
3. U.S. Preventive Services Task Force. Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2008 Aug 5; 149 (3): 185-191.
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Competing Interests: None declared.
Published on: (17 February 2010)
Page navigation anchor for What would YOU do, Doc?
What would YOU do, Doc?
Anne Katz, Clinical Nurse Specialist
Birnie and Robinson have provided a valuable overview of the complexity of treatment decision making in localized prostate cancer. As a Clinical Nurse Specialist at the Manitoba Prostate Centre, my work focuses on working with newly diagnosed men with prostate cancer to help them and their partners come to a treatment decision. I spend an hour or more with these couples and over and over I hear that the man has gone...
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Birnie and Robinson have provided a valuable overview of the complexity of treatment decision making in localized prostate cancer. As a Clinical Nurse Specialist at the Manitoba Prostate Centre, my work focuses on working with newly diagnosed men with prostate cancer to help them and their partners come to a treatment decision. I spend an hour or more with these couples and over and over I hear that the man has gone to his trusted family physician and asked the question: "What would you do, Do?" And despite the evidence presented in Birnie's and Robinson's article, most men tell me that their physician responds, "Well, I'd have...." The problem with this well-meaning response is that it is personal and based on your values and not the patient's.
The article by Birnie and Robinson clearly points out value of clarifying the patient's values, providing unbiased information, and not presuming to know what the patient considers important. The next time someone asks you, "What would you do, Doc?", please consider the value of your hypothetical response.
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Competing Interests: None declared.