Low-risk prostate cancer patients in Canada may be opting for treatment with major life-changing side-effects without fully understanding other options, including the choice to forego treatment unless the disease progresses, a new report reveals.
"The Prostate Cancer Control in Canada: A System Performance Spotlight Report," produced by the Canadian Partnership Against Cancer, shows more could be done to help patients understand their disease, treatment options and side effects and to provide patient-centred care.
"While the cancer community has suspected wide variations in treatment, this is the first time we've been able to investigate it using pan-Canadian data," said Heather Bryant, M.D., Ph.D., vice president of cancer control at the partnership. "Treating prostate cancer involves helping men select the right treatment option for the best outcome balanced with understanding the potential side effects of treatment, which can significantly affect men's quality of life, even as they survive their disease."
Active surveillance, the preferred approach for managing low-risk prostate cancers, involves monitoring levels of prostate-specific antigen (PSA) in the blood every several months, along with regular prostate biopsies and rectal exams, watching for signs of cancer progression. Recent clinical trial results have shown that men with low-risk prostate cancer who received surgery and/or radiation did not have survival advantage over men on active surveillance. The advantage of active surveillance is that the risk of treatment-related side effects, including urinary incontinence and erectile dysfunction, can be avoided.
While the report's data suggested that three-quarters of men with low-risk prostate cancer in Manitoba and Prince Edward Island had opted for active surveillance, more than half of low-risk prostate cancer patients in British Columbia, Alberta, Saskatchewan and Nova Scotia were treated with surgery, radiation, or a combination. Inconsistencies in the number of men placed on active surveillance suggest inconsistencies in its presentation to patients as a favourable option.
"One in eight Canadian men will face a diagnosis of prostate cancer in their lifetime," said Stuart Edmonds, M.D., vice president, research, health promotion and survivorship at Prostate Cancer Canada. "The data contained in this report have the potential to provide important evidence to improve practice and lead to better outcomes for men."
The report features voices of prostate cancer survivors from different parts of the country. Their input provides anecdotal validation of the inconsistency in treatments. Prostate cancer survivors stressed the importance of informed choice and also shared some of their challenges dealing with long-term side effects of treatment.
A Manitoba prostate cancer patient interviewed for the report commented, "My experience was that I didn't learn about the side effects or anything until really after the treatment (…) Not being offered you know, something up front before I got the treatments." Another said: "research your options, there's so many options out there…so make sure it's a choice you're happy with, because I have some regrets."
The report also features results from prostate cancer patient satisfaction surveys from across Canada that point to a greater need for emotional support, with some men reporting symptoms of anxiety and depression.
"Prostate cancer is the leading cancer in Canadian men," said Claire Lamont, country director, Movember Canada. "We've created True NTH, a comprehensive global prostate cancer support program in partnership with Prostate Cancer Canada that provides much needed guidance and services to all men navigating their way through the varying stages of their prostate cancer journey, along with support for their families and caregivers."
As the report shows, while most prostate cancers are diagnosed at an early stage, many men are still diagnosed with or progress towards end-stage disease and require effective, patient-centred end-of-life care. The report's data suggests less than 40% of men who go on to die of prostate cancer receive radiation therapy for pain management in their last year of life, despite evidence of its effectiveness in providing relief. Prostate cancer patients also tend to wait longer for radiation therapy than patients with breast, colorectal or lung cancers in various provinces, the report found.
In 2012, nearly $542 million was invested in cancer research in Canada; of that, more than half was invested in cancer site-specific research, with 13.2 percent directed to prostate cancer. While this was less than the site-specific research investment for breast cancer (26.5 percent), it was double the investments for research into lung cancer (6.7 percent) and colorectal cancer (6.7 percent).
For more information: prostatecancer.ca