PCATS, PARTIN TABLES, AND PTSD: ASSIMILATING KNOWLEDGE HELPS MEN AVOID BUMPS ON
THE INFORMATION HIGHWAY
The good news is that men with prostate cancer have access to multiple
treatment options, which are often very effective, and to massive amounts
of information—from doctors, other health professionals, survivors,
cancer organizations and societies, researchers, books, newspapers, videos,
and the Internet. The bad news is that, often, a diagnosis of prostate
cancer brings with it fear and anxiety; feelings of numbness, detachment,
or estrangement; anger; difficulty concentrating; and avoidance—of
others, of thinking, of discussing the disease, and of making decisions.
Into this precarious mix, add the various tables, nomograms, assessment
tools, and decision aids that have proliferated alongside of improvements
in diagnosing prostate cancer and targeting prostate cancer treatment.
The result can be a man (and his partner) suffering from something close
to post-traumatic stress disorder (PTSD), with a limited ability to attend
to anything, and feeling overwhelmed with information and afraid of making
the “wrong” treatment decision. As one of Dr. Andrew Matthew’s
patients lamented, “I didn’t go to medical school for twenty
years to make this decision. Can’t someone make it for me?”
The answer is no, for many reasons. First of all, only you can make decisions
according to what you consider most important, adding to those decisions
what Dr. Matthew of Princess Margaret Hospital calls “personal value.”
Second, many treatment decision aids help promote increased understanding
of prostate cancer and its treatment, enabling men to investigate options
and probable outcomes, to avoid risk distortion or unrealistic expectations,
and, most important, to assimilate information and connect it to their
individual situations. And information assimilation is the key to making
the decisions that are right for you—and to living with those decisions.
(To hear Dr. Matthew’s presentation “Navigating the emotional
side-effects of prostate cancer,” visit the meeting archives of
UsToo! Brampton.)
Of course, no table, nomogram, or online assessment tool can replace
the ongoing counselling of experts in the medical profession—urologists,
oncologists, nutritionists, physiotherapists, and psychiatrists, to name
a few. Professional treatment decision counselling is sometimes an option,
too, and comes highly recommended. Still, by making plain some of the
data or categories upon which recommendations are based, assessment tools
offer men insight into what factors they should consider when faced with
decisions about their cancer, treatment, or lifestyle. So let’s
look at a few.
Prostate Cancer Research Foundation of Canada’s PCATs
Recently, the Prostate Cancer Research Foundation of Canada unveiled plans
for a comprehensive suite of interactive prostate cancer assessment tools
(PCATs) on its website. There are three PCATs currently available:
PCAT 1 calculates the likelihood that a biopsy will discover prostate
cancer based on a man’s age and the findings of a digital rectal
exam (DRE) and a prostate-specific antigen (PSA) blood test. (For example,
a 65-year-old with a suspicious digital rectal exam and a PSA level of
10 is said to have a 53.5 % chance of “having prostate cancer on
needle biopsy.”)
PCAT 2 determines the likelihood that the Gleason sum found during a
biopsy is higher than the Gleason sum found during the final pathology
of the removed prostate. (The Gleason sum helps doctors diagnose how abnormal
the cancer cells are and how quickly they might be expected to grow, but
the Gleason sum determined by a biopsy may be different than one determined
after prostate removal, when the whole prostate may be examined microscopically.)
This PCAT, then, gives a statistical picture of “who may harbour
an aggressive tumor at final pathology, despite having a low Gleason sum
at biopsy.”
PCAT 3 gives percentages for the likelihood that a man’s cancer
has spread beyond the capsule of the prostate. The calculation is based
on the following: PSA level, stage of the cancer (T1c to T3), Gleason
score (0 to 8 or 9), percentage of positive cores upon biopsy, and percentage
of cancer to the total of biopsy tissue.
As you can see, to use these PCATs effectively, you will need to learn
about your cancer and the various prognostic and diagnostic indicators
used by physicians. It would certainly be useful to discuss with your
doctor the pathologist’s report on your biopsy. Perhaps you could
even visit the Prostate Cancer Research Foundation of Canada’s website
from your doctor’s office. (Click here for the page on prostate
cancer assessment tools.)
Other Nomograms, Partin Tables, and Prostate Cancer Assessment Tools<br>
Other assessment tools are available. The Sloan-Kettering Cancer Center
offers prostate cancer nomograms at the pre-treatment stage, the post-radical
prostatectomy stage, and the hormone refractory stage. These nomograms
calculate the probability of various situations (e.g., likelihood of organ
confined disease) as well as of being cancer free or of survival. Additional
tools calculate the prostate’s volume, PSA doubling time, and general
life expectancy. Again, you need to prepare yourself with data about your
cancer before visiting this site. (Click here to visit the prostate nomograms
of Sloan-Kettering.)
A Partin table lookup function is provided by the website of the James
Buchanan Brady Urological Institute at Johns Hopkins. These tables can
help men and their doctors predict the “definitive” stage
of cancer, the one the pathologist finds upon examination of the removed
prostate. (To visit this page, click here.)
Some support groups also make various prostate cancer assessment tools
available. The Prostate Cancer Networking Group of Greater Cincinnati
offers one, which comes recommended by prostate cancer survivor and author
Harold Gopaul. It calculates PSA doubling time (PSADT) and PSA velocity
(PSAV). (To access the calculator, click here.)
For more about these and other assessment tools please visit the page
on prediction tools provided by the CPCN.
And remember, after the shock passes, assimilating information from reputable
sources and, under the guidance of medical professionals, applying this
information to your specific situation will help you avoid the bumps on
the information highway.
