'Mismatched' prostate cancer treatment is more common than expected

More than one-third of men with early prostate cancer who participated in a study analyzing treatment choice received therapies that might not be appropriate, based on pre-existing problems with urinary, bowel, or sexual function. The prevalence of these treatment "mismatches" could reflect patient unwillingness to discuss such problems with their physicians, according to the authors of the study, which will appear in the Jan. 1, 2008, issue of Cancer.

"Prostate cancer treatment directly affects very personal things that most people aren't comfortable talking about: urinary, bowel, and sexual function," said James Talcott, MD, SM, of the Center for Outcomes Research at Massachusetts General Hospital Cancer Center, Boston, who led the study. "In this case, however, having that information matters because the three major treatments available to patients have different patterns of potential side effects. Knowing if patients already have problems in these areas should help guide treatment decisions."

To investigate the frequency of treatment mismatches, the team enrolled patients treated for early prostate cancer at four Boston centers over a 6-year period. Study participants completed a questionnaire before beginning treatment and subsequent questionnaires at intervals of 3, 12, 24, and 36 months after they entered the study. The questionnaires were designed to assess urinary incontinence and other urinary problems, along with bowel and sexual dysfunction. Participants were also asked to assess their level of distress with any symptoms they experienced.

Of the almost 440 patients who completed the entire study, 89% reported having some level of urinary, bowel, or sexual problem before beginning treatment. Those participants were classified into four groups, and the study results showed similar levels of treatment mismatches in all groups. Since patients take many considerations into account when choosing therapies, the surveys asked about several factors that might affect those decisions, none of which could account for the mismatched choices. As expected, patients reporting pre-existing conditions were more likely to have problems after treatment if they had received a mismatched treatment.

"It could be that treatment choices are determined by factors other than those we asked about, or patients may decide to go ahead with mismatched treatments for their own reasons, knowing the risks," Dr. Talcott said. "But it also could be that the open, frank conversations patients should have with their doctors aren't taking place or that doctors aren't making it clear to patients why they should be forthright about urinary, bowel, or sexual problems they are having."