Is Shared Decision Making in Prostate Cancer Restrained by Evidence-Based Medicine?

Context: Evidence-based medicine (EBM) forms the basis for treatment decisions in many disease areas including prostate cancer, but such decisions may not necessarily be appropriate for every patient. Objective: This review examines clinical data relating to the management of prostate cancer, including chemoprevention, prostate-specific antigen (PSA) screening and timing of androgen-deprivation therapy (ADT). Evidence acquisition: During the 2010 Annual Congress of the European Association of Urology in Barcelona, Spain, a satellite symposium was held on the individualised management of patients with prostate cancer. This paper is based on one of the presentations at the symposium. Data were retrieved from recent review articles, original articles and abstracts relating to prostate cancer management including chemoprevention, screening and ADT, as well as treatment of prostate cancer from the patient's perspective. Evidence synthesis: A number of options can be considered in the management of prostate cancer, whether one takes the route of preventing the disease, actively screening men in order to identify tumours at an early stage or to focus on treating the disease with curative intent. One of the most promising chemopreventative strategies involves the 5 alpha-reductase inhibitors; data are also accruing on toremifene, a selective oestrogen-receptor modulator. Screening for prostate cancer remains controversial while an active surveillance for presumed insignificant disease is gaining in popularity. ADT remains the mainstay of treatment for locally advanced and metastatic prostate cancer; intermittent ADT is gaining acceptance as a means to reduce associated side-effects of treatment. Research shows that patients want to be actively involved in the treatment decision-making process. Conclusions: EBM should not preclude the Urologist considering other treatment options for patients with prostate cancer, who themselves want to participate in selecting the most appropriate treatment. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.