“What I Wish My Patients With Cancer Would Do.”
Prostate cancer has recently been on my mind.
I recently wrote this:
Would you be surprised if I told you that many patients with advanced prostate cancer do not get the preferred treatment for their disease?
Surprising, right? And disturbing.
I will use a troubling new study to springboard a discussion about how you can optimize your visit with your healthcare provider.
For patients with advanced prostate cancer who do not respond to lowering testosterone, only three in 10 receive the recommended first-line treatment intensification.
That’s the finding of a study recently published in JAMA Network Open.
Today, I’ll review the new study before sharing some tips for getting the most out of a doctor’s visit.
What is Advanced Prostate Cancer?
First, some basics.
Advanced (metastatic) prostate cancer refers to prostate cancer that has spread beyond the prostate gland to other parts of the body.
Prostate cancer is metastatic if it has spread to areas such as these:
- Lymph nodes outside the pelvis
- Bones
- Other organs, such as the liver or lungs
We may conveniently divide prostate cancer into four stages:
- Early-Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver, or lungs.
We sometimes diagnose metastatic prostate cancer when a patient initially presents.
On other occasions, we may find a distant spread of cancer later in your course, sometimes years later.
Castration-Resistant Prostate Cancer
Castration-resistant prostate cancer (CRPC) is a type of advanced prostate cancer.
It occurs when prostate cancer continues to grow or spread despite treatment aimed at lowering testosterone levels, such as hormone therapy (also known as testosterone-depleting therapy or androgen deprivation therapy/ADT).
Hormone therapy is commonly used for advanced prostate cancer to reduce the male hormones (androgens like testosterone) that fuel cancer growth.
While hormone therapy typically slows cancer growth, castration-resistant prostate cancer develops when cancer cells become resistant to this treatment and can grow even with low testosterone levels.
A New Study Shows How Often Docs Get It Wrong
“Success is stumbling from failure to failure with no loss of enthusiasm.” — Sir Winston Churchill.
With that background, let’s move on to the provocative new study results.
A study reviewed past surveys from 107 doctors collected between 2018 and 2022.
These surveys were connected to the medical records of 617 adult patients diagnosed with metastatic castration-sensitive prostate cancer.
The doctors who treated these patients worked in either community hospitals (64 percent) or academic/cancer centers (36 percent).
Study Results
Around 30 percent of those with metastatic castration-sensitive prostate cancer (mCSPC) received first-line treatment intensification (TI).
Most patients received androgen deprivation therapy (ADT) alone, whereas TI includes the addition of an androgen receptor pathway inhibitor (ARPI), chemotherapy, or both.
The National Comprehensive Cancer Network (NCCN) issued recommendations for treatment intensification — by adding either the ARPI (2019) or chemotherapy (2017) to block testosterone — for those with metastatic castration-sensitive prostate cancer (mCSPC).
Why Aren’t Doctors Following Best Practice?
The researchers investigated why physicians made their treatment choices.
Here are the main reasons:
- The clinician thought they were following treatment guidelines
- Concern about the tolerability of combined treatment
- More modest prostate-specific antigen (PSA) reduction objectives than data support.
While the study showed that doctors who based their treatment choices on established guidelines were roughly 3.5 times more likely to select the recommended treatment, some doctors who reported adhering to the guidelines did not.
The data clearly shows that most patients should have treatment intensification.
What Can You Do As A Patient? What I Wish My Patients With Cancer Would Do.
Here are some ways you can optimize your medical visits.
Gather information, ask questions, actively engage with your care provider, and explore options like telehealth.
Here’s a more detailed breakdown:
Before the Visit
- Prepare a List of Questions: Jot down any concerns, symptoms, or questions you want to address during the appointment. If you have cancer, The National Comprehensive Cancer Center guidelines for patients are a good starting point.
- Gather Relevant Information: Collect your medical history, medicine list, and recent test results.
- Review Your Insurance: Understand your deductible, copay, and potential out-of-pocket costs.
- Consider Telehealth: Explore telehealth options (for convenient and flexible appointments, if appropriate).
- Know how to access after-hours support: Learn how to access care outside of regular office hours.
During the Visit
- Be Transparent: Share concerns, including mental health or lifestyle ones.
- Ask Clarifying Questions: If you don’t understand something, don’t ask for explanations.
- Actively Participate: Engage in the discussion and express your preferences and concerns.
- Take Notes: Jot down key information, recommendations, and next steps.
- Explore Additional Support Services: Learn about services like social work, nutrition counseling, or senior centers.
After the Visit
- Follow-up: Follow through with any recommended tests, medications, or lifestyle changes.
- Schedule Future Appointments: Plan your next check-up or follow-up appointment.
Seek Second Opinions
Consider seeking a second opinion if you have concerns about a diagnosis or treatment plan.
Share Feedback
Please provide feedback to your healthcare provider or practice to help them improve their services.
Thank you for reading “What I Wish My Patients With Cancer Would Do.” Please consider signing up to follow me.
