Men diagnosed with clinically localized prostate cancer frequently have distress and uncertainty about what may be the best approach to treatment, and a significant minority may regret their choice later after completing treatment. Doctors are the primary resource for obtaining the information needed to make a treatment decision, and with a variety of predictive models they can give prostate cancer patients individualized information about the stage and possible treatment options.
Providing accurate information is essential for informed consent for any treatment, and open, honest discussion is an essential component of a health doctor-patient relationship. With CaP Calculator, our aim was to develop a similarly effective tool for doctors to help personalize treatment recommendations, reduce patient distress and enhance the doctor-patient relationship for men with newly diagnosed clinically localized prostate cancer.
We currently recommend that CaP Calculator be used by a health care professional experienced in the management of prostate cancer.
Often, controversy or disagreement exists regarding the best clinical practices or expected treatment outcomes. While we have attempted to make a large body of evidence-based results available in a convenient format for comparing estimates, CaP Calculator is to be used as a resource rather than as a substitute for medical decision-making or treatment.
Here are some of the reasons why CaP Calculator is to be used in the context of an existing relationship between men with prostate cancer and health care professionals:
1. All estimates are based upon patients treated primarily at academic medical centers and could differ (possibly better or worse) in the community setting due to patient or physician bias regarding treatment preferences;
2. Some potentially useful or investigational markers for outcomes prediction used by some may not be widely available (e.g. DNA ploidy) or less widely used (e.g. PSA doubling time, perineural invasion or lymphovascular invasion);
3. Most published data give estimates over a five to ten year time horizon but may not fully reflect the possibility of treatment outcome;
4. Determination of clinical stage and Gleason score may differ based upon the experience and/or clinical judgment of the health care professional;
5. Shifts in clinical stage and Gleason score over the past 10-20 years may results in different outcomes than in currently published medical literature;
6. The extent of lymph node sampling may vary and will influence the likelihood of finding positive nodes;
7. Because some patients in published studies don’t continue to see specialists if everything is going well, follow-up bias may underestimate the effectiveness of treatment;
8. Fine needle aspiration biopsy does not provide adequate information to use CaP Calculator due to difficulty in accurately determining Gleason score and potentially important additional information on the core biopsies;
9. New types of treatment or information not included in CaP Calculator may have important implications for risk assessment and treatment recommendations;
10. CaP Calculator is designed to reduce patient distress and uncertainty about prostate cancer and treatment options by enhancing the doctor-patient relationship, not by circumventing it.
Everyone interprets the same statistical results differently. For example, a 10% risk of lymph node involvement may sound reassuring to one patient but may cause another man a great deal of anxiety. While more detailed information can be helpful, we believe that the anxiety and stress about its implications may be minimized by active discussion of CaP Calculator results with health care professionals.
For men with prostate cancer, we currently suggest that their health care professional register, use CaP Calculator and review the results together. Based upon that important discussion, the results can be interpreted and placed in context prior to making decisions regarding treatment.