Patient Perspectives on Prostate Cancer: Quality of Life and Treatment Decisions "Presentation" - Leszek Izdebski
July 24, 2024
At the CAncer or Not Cancer: Evaluating and Reconsidering GG1 prostate cancer (CANCER-GG1?) Symposium, Leszek Izdebski discusses the complex decision-making process for prostate cancer patients considering active surveillance (AS). He emphasizes the importance of quality of life considerations, noting that different patients have varying priorities, such as maintaining the ability to participate in extreme sports versus concerns about treatment side effects.
Biographies:
Leszek Izdebski, Chair, UCSF, Prostate Cancer, Patient Advocacy Committee, San Francisco, CA
Biographies:
Leszek Izdebski, Chair, UCSF, Prostate Cancer, Patient Advocacy Committee, San Francisco, CA
Read the Full Video Transcript
Leszek Izdebski: Interestingly enough, there was a conversation about MRI. So again, looking at that, I didn't have a lot of confidence that I knew what was going on. The other aspect that we didn't discuss here is quality of life, and erection has two sides of it. Quality of life, if the diagnosis was incorrect, and quality of life, if we unnecessarily were treated. Different patients have very different perspectives on that. For me, it was more important when I started looking at the data that there was a chance that I could have, in the future, metastatic cancer. It wasn't about morbidity, it wasn't about death. It was really about my ability to participate in extreme sports that are very important to me. So partially my decision was based on that.
For other patients, that perspective is completely different. They actually think about the impact of the radical prostatectomy on their lifestyle. So again, we cannot apply the same equation to every single patient. It just doesn't work that way for us. Then I also started looking at data in the context of this presentation at what happens with adherence to AS. And unfortunately, it's not very good, and the majority of the studies that are out there look at controlled studies where patients are followed up because they're enrolled in this study. And at that point, the adherence is actually pretty good. The minute it's looked at much more broadly, that adherence actually is much, much lower.
So when I was thinking about how do we react to downgrading, well first of all, the biopsy is pretty painful. It's not a pleasant experience. We remember that quite well. So if we feel, "This is pre-cancerous. This is not really cancer," the probability of us actually going for the biopsy again soon decreases.
I have another condition where I was declared pre-cancerous. I know how adherent I am to what I'm supposed to do. I'm trying to be good about it; I'm not very good about it. So from my point of view, we really need to get to the point where the determination of the risk is much better than we currently have. It's not just Gleason, it's not just MRI. There has to be a better set of tools for us than just those two or three different diagnostic tools.
Leszek Izdebski: Interestingly enough, there was a conversation about MRI. So again, looking at that, I didn't have a lot of confidence that I knew what was going on. The other aspect that we didn't discuss here is quality of life, and erection has two sides of it. Quality of life, if the diagnosis was incorrect, and quality of life, if we unnecessarily were treated. Different patients have very different perspectives on that. For me, it was more important when I started looking at the data that there was a chance that I could have, in the future, metastatic cancer. It wasn't about morbidity, it wasn't about death. It was really about my ability to participate in extreme sports that are very important to me. So partially my decision was based on that.
For other patients, that perspective is completely different. They actually think about the impact of the radical prostatectomy on their lifestyle. So again, we cannot apply the same equation to every single patient. It just doesn't work that way for us. Then I also started looking at data in the context of this presentation at what happens with adherence to AS. And unfortunately, it's not very good, and the majority of the studies that are out there look at controlled studies where patients are followed up because they're enrolled in this study. And at that point, the adherence is actually pretty good. The minute it's looked at much more broadly, that adherence actually is much, much lower.
So when I was thinking about how do we react to downgrading, well first of all, the biopsy is pretty painful. It's not a pleasant experience. We remember that quite well. So if we feel, "This is pre-cancerous. This is not really cancer," the probability of us actually going for the biopsy again soon decreases.
I have another condition where I was declared pre-cancerous. I know how adherent I am to what I'm supposed to do. I'm trying to be good about it; I'm not very good about it. So from my point of view, we really need to get to the point where the determination of the risk is much better than we currently have. It's not just Gleason, it's not just MRI. There has to be a better set of tools for us than just those two or three different diagnostic tools.