To treat or not to treat
This web tool was developed to help men with prostate cancer decide on the best treatment option, especially if the cancer does not seem aggressive.
THOUSANDS of men in Malaysia will be diagnosed with prostate cancer this year.
As doctors get better and better at identifying prostate cancer early, more and more men are diagnosed, then left with the choice of what to do about it.
For some men, the clear course of action is to go for radical (or curative) treatment to treat an aggressive cancer.
Doctors are excellent at identifying men who fit these criteria.
For other men, that radical treatment may do more harm than good.
Many men’s prostate cancer may be so slow to grow that it won’t cause a problem for a decade or more.
It is a common saying among urologists that more men die along with their prostate cancer, rather than die from their prostate cancer.
For men with this less aggressive prostate cancer, their doctor will often present them with a choice: to treat or to monitor.
The choice to treat radically will mean either surgery to remove the prostate or radiotherapy.
Side effects of these radical treatments include erectile dysfunction and urinary incontinence – both of which can have very serious impact on a man’s quality of life.
The choice to monitor means going on active surveillance.
This is where the patient and the doctor watch and wait to see if there are any changes in the cancer.
This monitoring will often be done by a combination of prostate antigen specific (PSA) tracking, magnetic resonance imaging (MRI) and biopsies.
However, how does a man decide which way to go?
On one hand, the surgery or radiotherapy may mean that he becomes cancer-free. But at what cost to the rest of his body?
Is he willing to lose his ability to use the bathroom without a diaper, or his sexual function?
What if his cancer is the slow-growing type and the big, risky surgery is undertaken for very little benefit?
On the other hand, monitoring a man’s cancer means switching patients’ mentality towards the cancer as more of a chronic disease – something to live with, not die from.
But how does one know whether their cancer is a slow-growing one? What if it turns out to be aggressive?
A tool developed by consultant urologist and University of Cambridge, United Kingdom, lecturer Dr Vincent Gnanapragasam hopes to help with this dilemma.
Called Predict Prostate, it is a personalised tool to give an overall survival estimate following a prostate cancer diagnosis.
Launched in March, it brings together the latest evidence and mathematical models into an easy-to-use website.
The tool was developed with data from over 10,000 men with prostate cancer from England and retested in 2,500 Chinese, Malay and Indian men from Singapore.
It takes routinely-available information and details about the patient, including his age and other illnesses, then gives the patient a 10-15 year survival estimate.
Importantly, the tool also estimates how his chance of survival differs, depending on whether he opts for monitoring or treatment, providing context of the likelihood of success of treatment and risk of side effects.
“This tool is about empowering patients and their clinicians to make decisions based on better evidence.
“In some cases, treatment will be the right option, but in many others, patients will want to weigh up the treatment benefits versus the risk of side effects.
“It will also show men who do need treatment a realistic estimate of their survival after treatment,” says Dr Vincent, who is originally from Petaling Jaya, Selangor.
The researchers caution that the tool is strongly recommended for use only in consultation with a urologist or oncologist.
It is not suitable for men with very aggressive disease or who have evidence of metastatic or spread disease at the time of diagnosis.
The research was done in collaboration with Dr David Thurtle, who, with Dr Vincent, are both members of the Academic Urology Group in Cambridge, and Professor Paul Pharoah from Cambridge’s Department of Cancer Epidemiology.
The study was published in the journal PloS Medicine.
The tool is at www.prostate.predict.nhs.uk and a podcast about it can be found at tinyurl.com/ yyzdayx6.