When determining which treatment a patient should receive for localised prostate cancer, urologists should be prepared to not just compare the medical effectiveness of the available treatments but also the comparative harms for individual patients.
Dr. Sam Chang (US) addressed Plenary Session 5 at EAU19 on Monday morning: “We want the evidence-based recommendation, but must also take into account what the patient considers important. When comparing radical prostatectomy, radiation therapy and active surveillance, each approach has its ups and downs. For patients however, it’s mainly the side-effects that determine their choice.”
Chang gave this year’s AUA Lecture, encouraging the audience to make more of patient-reported outcome (PRO) when it came to localized prostate cancer treatment: “As urologists, we should study the quality of life and patient-reported outcomes for several reasons.”
“First of all, there is the importance of shared decision making. In the doctor-patient relationship, we can define paternalistic, informed and, ideally, shared decision-making. In the latter, the concerns of the patient are factored into the doctor’s advice.”
Other reasons include the potential for patient-reported outcomes to act as a basis of comparison among contemporary treatments, attempts to determine the overall impact of therapy on a patient’s choice, and the fact that PROs can detect more symptoms or treatment side-effects than traditional physician assessments.
Patient-reported outcomes could even impact survival. Dr. Chang pointed at trials in lung cancer patients undergoing chemotherapy, in which patients with web-based monitoring did better than those with standard monitoring.
Dr. Chang also showed some real-time prediction tools that factored in the patient’s statistics as well as several personal statements, leading to a dynamically-generated, individually-tailored predictive model.
Dr. Chang’s lecture chimed with the panel discussions on PCa management that opened Plenary Session 5. The panel consisted of a (young) urologist, a radiation oncologist, a geriatrician, but also a psychologist, Dr. Lara Bellardita (IT). Dr. Bellardita gave insights on the management of patient anxieties, explaining how scientific data can be partially filtered by a patient’s own expectation and emotions.