Reducing PSAnxiety: The importance of noninvasive chronic disease management in prostate cancer detection and treatment

[Limits to the power of medicine to define disease and risk factor, and quarternary prevention]

Patient safety means to avoid unnecessary harm produces by health care activities. Quaternary prevention is a medical activity that try to avoid or decrease the health consequences of unnecessary or excesive health care. Physicians' definition of health, risk factor and disease justify many unnecessary medical interventions. It is critical to control an excesive medical technological actitude that allows excesive medical interventions. The medical power of definition of health and disease transform risk factor in a border which usually overlap with the disease field. We need research on quaternary prevention, and to develop activities of quaternary prevention which help in stopping the dissemination of health care (preventive, curative, diagnostic or therapeutic) of little value.

The impact of a suspicious prostate biopsy on patients' psychological, socio-behavioral, and medical care outcomes

OBJECTIVE

To evaluate the psychological, socio-behavioral, and medical implications of apparently false-positive prostate cancer screening results.

METHODS

One hundred and twenty-one men with a benign prostate biopsy performed in response to a suspicious screening test (biopsy group) and 164 men with a normal prostate-specific antigen (PSA) test result (normal PSA group) responded to a questionnaire 6 weeks, 6 and 12 months after their biopsy or PSA test.

RESULTS

The mean (+/-SD) age of respondents was 61+/-9 years (range, 41 to 88 years). One year later, 26% (32/121) of men in the biopsy group reported having worried "a lot" or "some of the time" that they may develop prostate cancer, compared with 6% (10/164) in the normal PSA group (P<.001). Forty-six percent of the biopsy group reported thinking their wife or significant other was concerned about prostate cancer, versus 14% in the normal PSA group (P<.001). Medical record review showed that biopsied men were more likely than those in the normal PSA group to have had at least 1 follow-up PSA test over the year (73% vs 42%, P<.001), more likely to have had another biopsy (15% vs 1%, P<.001), and more likely to have visited a urologist (71% vs 13%, P<.001).

CONCLUSION

One year later, men who underwent prostate biopsy more often reported worrying about prostate cancer. In addition, there were related psychological, socio-behavioral, and medical care implications. These hidden tolls associated with screening should be considered in the discussion about the benefits and risks of prostate cancer screening.

Opportunities for disease state management in prostate cancer

In this paper, we examine how the management of prostate cancer lends itself to a disease state management (DSM)-based approach, and propose a framework that emphasizes the patient-provider-caregiver triad in managing the long-term implications of the condition. There is often no clearly superior approach to the management of patients with prostate cancer (eg, watchful waiting and hormonal therapy), and each option entails different trade-offs in quality of life. Ideally, the physician and patient discuss the options, issues, and patient preferences for treatment through the shared decision-making process. A family caregiver such as the spouse of the patient is often involved in the treatment decision and in the long-term management of the cancer experience. In order to develop a DSM program supporting both patient and caregiver, educational, psychosocial, and health care system support needs should be tailored to each phase of cancer treatment/management. To embrace the unique aspects of prostate cancer management, the proposed framework emphasizes communication among the patient-caregiver-provider triad, inclusion of family caregivers in the program, cancer phase-specific support, and psychosocial services as a basis for implementation and evaluation of a DSM program in prostate cancer.