Nurse Practitioner Lauren Engel explains how understanding the type and stage of prostate cancer, along with a patient's personal priorities, can help guide treatment decisions. She also emphasizes the importance of staying in close communication with the care team, reassuring patients that most side effects can be managed effectively when addressed early.
Lauren Engel:
I try to explain to people the different types of prostate cancer, and so I try to explain to them that someone who has a low-grade Gleason 6 cancer, that's who your friend is talking about that, "Oh, you got diagnosed at 90, you're going to die with this, you don't need treatment for this." But sometimes, by going through the Gleason score, I think that can be helpful. Sometimes talking about if they've had metastases on scans, even just explaining to them, "Your cancer's spread outside the prostate. This is something that we need to address now so it doesn't cause more complications down the line."
But I think there certainly is a hesitancy there, where people are feeling fine, and that's the hardest person to put on treatment is the person that feels fine, because I'm sitting in front of them telling them all these possible side effects, but they say, "If you didn't tell me, I wouldn't even know that I had cancer." And so, explaining to them, sometimes with lab work, that the PSA is trending up, they have scans, anything like that, I think, can sometimes be helpful for that particular person.
I think some patients want to be told what to do, and I think localized prostate cancer is one of those situations where, in some cases, patients have two good options and it's up to them to decide. Other types of treatment options, we don't give patients the option, the medical doctor makes that decision. But in the appropriate patient, localized disease, they can either have surgery or they can have radiation, and either is good. I think what I try to do is go through the possible side effects, because I think that will help patients make a decision, and I think that if they can prioritize what side effects they might want to avoid more than anything, that can help in some way.
So if a man is really worried about his erectile function, he might be somebody that you would try to avoid surgery for if that's a huge concern for him. If a man is really worried about hormone therapy and the possible side effects of that, radiation might not be the right choice for them if the plan included hormone therapy, and therefore surgery might be better. Some men say, "I just want this out of me. I can't stand the idea of you telling me I have cancer and it's going to be in me during my eight weeks of radiation. Take it out."
A cancer diagnosis is very scary to a lot of people. It's completely understandable. But most people really do quite well on these treatments on a day-to-day basis, and most people continue to live their lives and they continue to work or do the things that they like to do and spend time with their family and their friends. And so, I think sometimes, reassuring people that they'll probably feel okay is really important. I'd say that's my biggest pearl.
And I think the second thing is that the communication, that's the other really important thing. So most of these side effects start off mild, and most of them can be treated when they're mild, and so staying in touch with your team and not being a hero. So there's no need to suffer and really have all these bothersome side effects at home until your next visit, which might not be for a month or three months. And so, calling us and knowing that it's never a bother to call us is the other important thing that I'd recommend.
This interview was produced with the generous support of Dana Farber Cancer Institute