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Home » EU Health, Health, Prostate Cancer

Need for a multidisciplinary approach to PCa

Submitted by on 14 Jul 2017 – 10:00

By Prof Giuseppe Morgia, Urology Section, Department of Surgery, University of Catania

Prostate cancer (PCa) represents the most common cancer in men in developed countries in 2013. Incident cases increased more for prostate cancer than any other malignancy globally, irrespective of development status. In fact, incidence and death rates have risen considerably between 1990 and 2013, with the steepest rise in age-standardized incidence rates of all cancers in men, and a higher percent change in developing versus developed countries (1)

With the worldwide diffusion of PCa screening, the number of prostate biopsy due to elevated prostate specific antigen (PSA) has increased over the years.

Although the PSA test lead to an increased risk of PCa at an early stage of the disease, it has limited specificity for detecting clinically significant tumours leading to unnecessary biopsies and detection and treatment of some indolent tumours. (2) For these reasons PSA screening is still controversial due to some limitations of the test and it is one of the most debated matters. (3)

As a consequence, active surveillance (AS) has gained popularity with the aims to mitigate the overtreatment of indolent disease and potentially harmful side effects of active treatments, retaining the option of definitive therapy for patients who are reclassified over time as high risk. (4)

Despite its several benefits, AS has been underutilised for men with localised prostate cancer for some reasons. One of these may be attributable to cancer-related anxiety on the follow-up management. In fact, the severity of distress may vary with perceptions of health and overall psychological adjustment. (5)

Distress of patients may be related to the uncertainty of the results of the visit, PSA and biopsy diagnosis during the follow-up that perpetuate anxiety, especially in predisposed men.

It is in fact known that as people wait, they increase in distress and other events during this time like experiencing negative emotions with anxiety and worry. In fact, it has been proposed that men who choose AS may be at greater risk of psychological distress because of the passive nature of the strategy.

Unfortunately, up to now it is not clear how to identify demographic predictors for these conditions.

Some previous studies have identified that some variables like impaired mental health and patient’s perceived importance of the physician in the treatment decision making process appear to be associated with poorer quality of life among AS patients.

Based on all these premises how can we centralise patients’ emotions and take care of their distress? First of all, it is now evident that physicians cannot work alone. In this context, the professional figure of psychologist should be more involved during the treatment decision making and counselling. Moreover, academic institutions of urologists (such as the European Association of Urology) and health organisations should strength their communication system in order to educate patients about PCa diagnosis and treatment strategy. A multidisciplinary team should be present at every atage of care, starting from screening, treatment and especially in AS protocols in order to provide an effective management of the disease.

References:

1. Dy, G. W., Gore, J. L., Forouzanfar, M. H. et al.: Global Burden of Urologic Cancers, 1990-2013. Eur Urol, 2016

2. Roobol, M. J., Steyerberg, E. W., Kranse, R. et al.: A risk-based strategy improves prostate-specific antigen-driven detection of prostate cancer. Eur Urol, 57: 79, 2010

3. Loeb, S.: Guideline of guidelines: prostate cancer screening. BJU Int, 114: 323, 2014

4. Cantiello, F., Russo, G. I., Cicione, A. et al.: PHI and PCA3 improve the prognostic performance of PRIAS and Epstein criteria in predicting insignificant prostate cancer in men eligible for active surveillance. World J Urol, 34: 485, 2016

5. Tan, H. J., Marks, L. S., Hoyt, M. A. et al.: The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer. J Urol, 195: 1724, 2016