The patient describes his experience of receiving a shock diagnosis of advanced prostate cancer, detected incidentally from a perceived strain injury. He describes the impact of the diagnosis and treatment on his lifestyle and sexuality, and how this has driven him to campaign for prostate cancer awareness and screening. He also describes his positive experience receiving abiraterone acetate, which has kept the disease at bay, but also exhibits his frustrations that this option is not available on the National Health Service in England despite demonstrable efficacy.
Healthcare professionals respond to the issues highlighted by the patient. The uro-oncology nurse specialists acknowledge that concerns about treatment toxicity, particularly the impact of hormone deprivation on ‘masculinity’ and psychosexual wellbeing, are of great importance to this patient population. They also describe their role within the patient journey: as their keyworker, advocate, and as a reliable point for advice at dealing with the side effects of treatment. While their role is gratifying, they also expressed concerns about the funding cuts and increased caseload of their profession, which can often lead to work left uncompleted, or at least not to the standard they desire for their patients.
The physician reflects on issues such as the challenges of developing a screening program for prostate cancer, but also the consequence of the absence of such programs on individual patients such as his co-author. The physician also discusses the dramatic changes in the space of treating advanced prostate cancer, the barriers to implementing treatment intensification in advanced prostate cancer, and emphasizes the importance that treatments are tailored to a patient’s co-morbidity profile, personal preferences, and lifestyle.
Written by: Kenrick Ng, MD, Cancer Research UK Clinical Research Fellow, Specialist Registrar in Medical Oncology, University College London Cancer Institute, London, Twitter: @kenrickng1
References:
- Collier, Tony, Shievon Smith, Michelle Greenwood, and Kenrick Ng. "Living with Advanced Hormone-Sensitive Prostate Cancer and Treatment with Abiraterone and Androgen Deprivation Therapy: The Patient, Nursing and Physician Perspective." Oncology and therapy (2020): 1-11.
- Leary, Alison, Jane Brocksom, Ruth Endacott, Louisa Fleure, Felicity Howdle, Morven Masterton, Anita O'Connor, Adrian Swift, Paul Trevatt, and Philippa Aslet. "The specialist nursing workforce caring for men with prostate cancer in the UK." International Journal of Urological Nursing 10, no. 1 (2016): 5-13.
- Ng, Kenrick, Shievon Smith, and Jonathan Shamash. "Metastatic hormone-sensitive prostate Cancer (mHSPC): advances and treatment strategies in the first-line setting." Oncology and therapy (2020): 1-22.
- James, N., H. Rush, N. Clarke, G. Attard, A. Cook, D. Dearnaley, S. Gillessen et al. "611O Abiraterone acetate plus prednisolone for hormone-naïve prostate cancer (PCa): Long-term results from metastatic (M1) patients in the STAMPEDE randomised trial (NCT00268476)." Annals of Oncology 31 (2020): S509.
- National Prostate Cancer Audit (NPCA). Results of the NPCA Prospective Audit in England and Wales for men diagnosed from Apr 1 2017 to Mar 31 2018. 2020. https://www.npca.org.uk/content/uploads/2020/01/NPCA-Annual-Report-2019_090120.pdf. Accessed 20 Sept 2020.