Prostate cancer patients give their doctors high marks

Prostate cancer patients give their doctors high marks

The interim evaluation of the HAROW study found that most patients with localized prostate cancer have a low risk, select the operation and feel medically well looked after.

The abbreviation stands for HAROW the five options for the treatment of localized prostate cancer: hormone therapy , active surveillance ( active monitoring ), radiotherapy ( radiation therapy ), surgery ( radical prostatectomy ) and watchful waiting ( expectant observation ).

The HAROW study is the largest study on the treatment of patients with localized prostate cancer in Germany. They started in 2008 and currently includes almost 1,500 patients. Plans are for a period of 5 years and 5000 patients. The study of the nonprofit Men's Health in collaboration with the BDU will be conducted (Professional Association of German Urologists eV), DGU (German Society for Urology eV), the BPS (Bundesverband prostate cancer self-help eV) and the Federation of prostate centers in Germany eV with financial support by a private company.

The aim of the study is to answer questions that are important for the patient and the doctor, but have not yet been clarified in other studies, for example, what is the value of individual treatment options under everyday conditions. To this end, both the patients and the study physicians in private practices and hospitals document the progress on a regular basis.

In the interim analysis in March 2010 1213 patients and 194 physicians were included. Most patients were 65-74 years old (54%), lived in a committed relationship (75%), were retired (64%) and had no other comorbidities (56%). The tumors have been most frequently due to an increased PSA value of 4-10 ng / ml (at 60%) at least 12 biopsies detected (at 39%), which means a stage T1c (52% to the TNM system, see growth and spread ). The Gleason score was 4-6 predominantly (59%), and nearly three quarters (72%) of the patients had a tumor with a low risk (according to Chism criteria: PSA level to 10 ng / ml and T1a-T2c and Gleason score to 6).

The course of the disease in 591 patients over a year resulted in 16% of an upgrade of the tumor category, usually after histological (histological) examination after surgery, and at 3% a progression of the disease, most commonly identified by a short PSA doubling time (PSA-DT ).

From 1190 patients with present treatment decision, 56% opted for radical prostatectomy, 12% for active surveillance, 11% for radiotherapy, 8% for a combination, 6% for hormone therapy and 2% for the wait and observe. Elderly and high-risk patients most likely chose a conservative approach, ie one of the latter two options. The decision was made on average after a month, and it took another month to surgery or the start of radiotherapy.

The quality of life of patients and their relationship with the doctor is an important part of HAROW study and was recognized with various questionnaire, some already more than a year.The assessment of quality of life with regard to general health, cancer and its change over time delivered by and large no unexpected results. Thus, the patient hardly and not affected increasingly felt in most areas, with the exception of sexual problems after an intervening treatment.

Your treating doctors questioned the patient almost always top marks: The statements on the care, support, activation, and information by the doctor agreed each 57-93% full and 9-28% more likely to (together about 95%). Less consent reached the accessibility of the doctor outside of office hours (together 69%) and the disclosure of information that do not directly relate to the treatment options (36-62%).

Conclusion of the authors

Prostate cancer patients feel cared for by their doctor well: The vast majority think that he is supporting, valuing, comprehensible information and involving in the therapeutic decision and that it gives them enough time for their decision. However, the results also show that not all doctors inform their patients adequately about self-help groups, rehabilitation facility, and a second medical opinions.