Educating Patients After a Prostate Cancer Diagnosis
You havejust undergone aprostate biopsy and, in most cases, you have tolerated the procedure very well. There may have been some blood in the urine or on your stool for a few days, however it has most likely ceased. If you have resumed sexual activity, your semen may still have some blood in it, which can either be red or brown and it may for remain that way for a few weeks. But overall you are feeling pretty good at this time until your urologist says, “Mr. Smith … I am sorry to tell you that your biopsy reveals that you have prostate cancer”.
Most patients immediatelybegin to panic. They have just been told the “C”-word and do not know what to think. Patients react to this information in various ways. Some are overwhelmed and others have a blank stare on their faces. If the spouse is present, I have seen the couple both begin to cry uncontrollably. Others have assumed that this was going to be the outcome of their biopsy and may be very matter-of-fact about the diagnosis. At this point however, the urologist must begin a process that educates and reassuresthe patient regarding their newly diagnosed disease. Most patients do not have a very good understanding of prostate cancer prior to diagnosis and this education process is crucial to the physical and mental well-being of the patient.
The overwhelming majority of patients are going to be cured of their disease, however at this point not all patients are ready to believe this. Immediately after the patient has been diagnosed, it is important to provide the patient with as much information as possible, but not to overload them with information that would interfere with a rational thought process.
At this first visit after the biopsy my approach has always been to be as reassuring as possible. There are several take home messages I feel that are very important for the patient to go away with:
- The vast majority of prostate cancer is very slow growing. This is not a disease that is going to adversely effectmost patients in the near future, and if left untreated and allowed to progress will not have a negative bearing for many years.
- Most cases are curable.
- Treatments for prostate cancer do not automatically result in the feared complications of urinary incontinence or erectile dysfunction. Not overwhelming the patients with information is very important.
After this initial discussion, the “wheres” and the “whats” of the cancer need to be discussed with the patient. The stage of the cancer is what I refer to as the “where” of the cancer. Is it only located in the prostate or has it spread to adjacent organs, lymph nodes or to distant locations? Most patients will undergo an imaging study that will help give some additional information with regards to whether or not the cancer has spread beyond the prostate. This can include a CT scan or some Urologists may prefer utilizing an MRI. A bone scan can be used to determine if the cancer has spread to bone, however if the grade of the canceris less than “seven” most urologists will not recommend this imaging study.
The “whats” of the cancer refer to grade of the tumor or the microscopic description of the cancer. Forprostate cancer we use the Gleasongrading system. Two areas of malignancy are analyzed and each given a score from one to five. The two scores are added to give an overall Gleason score out ofa possible score of 10. Most patients tend to have Gleason scores of either six or seven, intermediate grades of prostate cancer.
Lastly, a preliminary discussion is undertaken regarding various treatment options that are available to the patient. All treatment options are briefly discussed with the patient including observation, radical surgery, radiation therapy, cryotherapy and also high intensity focused ultrasound (HIFU). The goal of this discussion is not to inundate the patient with facts about these treatments, but to familiarize them with some of the concepts that treatment will entail.
The patients are asked to get therequested imaging studies and I always ask the patients to return for the next office visit with a significant other. At the follow-up visit, the results of the imaging studies are reviewed with the patient and serious discussion regarding treatment options is undertaken. In this information age that we live in, I always encourage the patients to surf the Internet to become better educated about their disease, as this makes the follow-up visit more meaningful. By doing this, I anticipate that patients will return with a series of questions that they would like answered and that will occur at the subsequent visit.
Prostate cancer is not by any means a death sentence. With the early detection that occurs today, and the outstanding treatments that are available survival is more likely than ever.
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.