Dialogue between patients and physicians critical to making “best choice” prostate cancer treatment decisions
In light of a treatment guide for low-risk prostate cancer patients published today by the Institute for Clinical and Economic Research (ICER) and Families USA, the American Society for Radiation Oncology (ASTRO) emphasizes the importance of discussion between patients and their providers and seeks to provide context for some of the treatment recommendations in the guide.
For patients with low-risk prostate cancer, the guide names active surveillance, prostatectomy and brachytherapy as the "proven best choices" for treatment and intensity-modulated radiation therapy (IMRT) and proton beam therapy as "lower-value options." Outcomes related to quality of life and toxicity, however, differ not only among treatment modalities but also among patients. Prostate cancer is a highly heterogeneous disease, and the relative costs and benefits of the multiple options to treat it can vary substantially among individual patients. The best decisions for prostate cancer patients incorporate patient preference, recommendations by both urologists and radiation oncologists and consider the specifics of each individual patient’s disease. While enhancing value is highly important, the “best choice” of treatment for any given patient is highly dependent on his expectations and preferences.
Additionally, not all patients are candidates for brachytherapy or surgery. Patients who score high on the America Urological Association’s symptom scale, for example, may experience heightened problems with low-dose rate brachytherapy and therefore benefit more from options such as external-beam radiation therapy or surgery. Moreover, new data support shorter fractionation regimens for IMRT for low-risk patients, and hypofractionation may therefore reduce the expense of IMRT. An external-beam radiation therapy option, whether IMRT or not, should be part of any comprehensive treatment recommendation guide.
Finally, patient education campaigns such as this one underscore the need to increase collaboration among the many groups involved in producing guidelines and other information for cancer patients. ASTRO, which counts nearly all practicing radiation oncologists in the United States among its members, remains committed to working with our partners in nonprofit, government and patient advocacy circles to achieve and promote excellence in patient care.
ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology • Biology • Physics (www.redjournal.org), Practical Radiation Oncology (www.practicalradonc.org) and Advances in Radiation Oncology (www.advancesradonc.org); developed and maintains an extensive patient website, RT Answers (www.rtanswers.org); and created the Radiation Oncology Institute (www.roinstitute.org), a nonprofit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit www.astro.org.