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Around 67,000 men are diagnosed with prostate cancer in Germany every year. Thanks to significantly improved early detection options, especially since the introduction of the PSA test, over 90 percent of all tumors are now detected at an early and thus usually curable stage. If the tumor is confined to the prostate, the affected person has several options for therapy: Internal radiation (brachytherapy), external radiation or radical surgery. In men with low-risk carcinoma, it is even possible to merely monitor the tumor closely (active surveillance, AS).
"If a man receives a diagnosis of prostate cancer, the fear of dying from the disease plays a significant role in the choice of therapy," says PD Dr. Friederike Kendel from the Institute of Medical Psychology at Charité. "The patient will ask himself how the risk of dying from the disease can be reduced by choosing a certain treatment," says the psychologist. For a well-informed patient decision, knowledge of the so-called mortality risk is therefore very significant.
To investigate how the figures on the mortality risk of the individual treatment options are perceived by the patient, the Charité working group led by Friederike Kendel conducted a study1 with a total of 292 patients. These were asked one to five years after diagnosis of localized prostate cancer how they assessed the risk of dying from this disease and not from another cause. Participants in the study were either under active surveillance (AS) or had undergone radical prostatectomy (RP).
Mortality risk is greatly overestimated
The study was able to impressively show that the mortality risk is significantly overestimated regardless of the treatment option chosen (surgery or waiting). For example, the self-assessed risk of about 20 to 50 pr-cent was significantly higher than the actual risk of an average of 0.1 to 3 pr-cent2/3. "It was particularly striking, however, that men who opted for surgical removal of the prostate assessed the mortality risk of Active Surveillance as particularly high," Dr. Kendel explained. While men who were under Active Surveillance thought that about 25 percent of men under AS would die from the prostate cancer, men who had undergone prostatectomy reported an average of as high as 51 percent.
"Information on the various treatment options and their mortality risk should therefore be presented and communicated to the patient as transparently as possible," Dr. Kendel emphasizes. Above all, he says, it is important to fundamentally relieve these men of the fear of dying from localized prostate cancer. This is because there are still completely false ideas that equate prostate cancer with a death sentence, regardless of the stage and aggressiveness of the tumor. Conveying realistic assessments not only requires a high degree of empathy on the part of the attending physician, but also involves a great deal of time. "But only when the figures are properly understood can one speak of an informed decision at all," sums up the Berlin psychologist.