PROSTATE CANCER SCREENING SHARED DECISION MAKING VIDEO

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1 PROSTATE CANCER SCREENING SHARED DECISION MAKING VIDEO 1 00:00:00,067 --> 00:00:10, :00:10,968 --> 00:00:12,701 So, you were given a decision aid sheet 3 00:00:12,701 --> 00:00:14,567 about prostate cancer screening when you checked in today. 4 00:00:14,567 --> 00:00:15,767 Did you get a chance to review that? 5 00:00:15,767 --> 00:00:16,868 PATIENT: Oh, yeah.

2 6 00:00:16,868 --> 00:00:18,868 I mean, I read it in the waiting room. 7 00:00:18,868 --> 00:00:20,901 No one in my family's had prostate cancer, 8 00:00:20,901 --> 00:00:23,934 so, I mean, should I even be worried about it? 9 00:00:23,934 --> 00:00:25,601 Well, about one in seven men like you, 10 00:00:25,601 --> 00:00:27,100 who are at average risk,

3 11 00:00:27,100 --> 00:00:29,601 will at some point be diagnosed with prostate cancer :00:29,601 --> 00:00:31,868 It's the most common major cancer in men :00:31,868 --> 00:00:35,367 Also, the risk goes up for men over :00:35,367 --> 00:00:37,601 For about one in 38 men, prostate cancer will be 15 00:00:37,601 --> 00:00:38,801 the cause of their death. 16

4 00:00:38,801 --> 00:00:40,701 Okay :00:40,701 --> 00:00:42,767 Good to know :00:42,767 --> 00:00:44,767 I've heard that doctors disagree about testing 19 00:00:44,767 --> 00:00:46,634 for prostate cancer, though :00:46,634 --> 00:00:48,267 What do you think about it? 21 00:00:48,267 --> 00:00:51,067 DOCTOR: Well, there are pros and cons to the test.

5 22 00:00:51,067 --> 00:00:52,534 Getting tested every one to two years 23 00:00:52,534 --> 00:00:54,734 could reduce your risk of dying from prostate cancer 24 00:00:54,734 --> 00:00:56,100 by 20% to 30% :00:56,100 --> 00:00:58,767 But the test can also lead to harm :00:58,767 --> 00:01:00,868 For some men, not getting tested and avoiding the harm 27

6 00:01:00,868 --> 00:01:02,067 is the right choice, 28 00:01:02,067 --> 00:01:04,434 even though they lose a small benefit :01:04,434 --> 00:01:06,901 It's complicated, so let's talk it through :01:06,901 --> 00:01:09,100 We don't have to come to a decision today :01:09,100 --> 00:01:10,501 Okay :01:10,501 --> 00:01:13,667 PSA stands for

7 prostate specific antigen :01:13,667 --> 00:01:15,701 The test for prostate cancer is a blood test 34 00:01:15,701 --> 00:01:18,000 that measures your PSA level :01:18,000 --> 00:01:20,067 A high PSA level might mean prostate cancer, 36 00:01:20,067 --> 00:01:21,534 but it could also mean 37 00:01:21,534 --> 00:01:23,734 things that aren't cancer, like an enlarged prostate.

8 38 00:01:23,734 --> 00:01:25,534 Does this make sense so far? 39 00:01:25,534 --> 00:01:27,834 Yeah, I think so :01:27,834 --> 00:01:30,300 Because we don't know for sure what's causing a high PSA level, 41 00:01:30,300 --> 00:01:32,834 we'd do more tests to find out :01:32,834 --> 00:01:35,534 If more tests showed that the likelihood of prostate cancer 43 00:01:35,534 --> 00:01:38,634 was high enough, then I might

9 recommend a prostate biopsy :01:38,634 --> 00:01:40,267 Okay :01:40,267 --> 00:01:44,400 And if you found cancer, then I'd get treatment, right? 46 00:01:44,400 --> 00:01:47,200 Unfortunately, that's not an easy answer :01:47,200 --> 00:01:49,834 The action we'd take would depend on how likely it is 48 00:01:49,834 --> 00:01:52,400 that the cancer we found will cause harm.

10 49 00:01:52,400 --> 00:01:54,133 Not all prostate cancer is dangerous :01:54,133 --> 00:01:59,934 But I thought all cancer was dangerous and could spread :01:59,934 --> 00:02:01,634 Well, unlike a lot of other types of cancers, 52 00:02:01,634 --> 00:02:03,067 most prostate cancers grow very slowly 53 00:02:03,067 --> 00:02:05,501 and won't cause problems or need treatment,

11 54 00:02:05,501 --> 00:02:08,367 so treating those cancers could do more harm than good :02:08,367 --> 00:02:11,167 But harmful cancers can spread, and treatment is needed 56 00:02:11,167 --> 00:02:12,868 to stop them :02:12,868 --> 00:02:14,868 The tough part is that we can't always tell 58 00:02:14,868 --> 00:02:17,033 which cancers are harmful and which ones would grow slowly

12 59 00:02:17,033 --> 00:02:18,501 and never need treatment :02:18,501 --> 00:02:22,033 If you did find the harmful kind, 61 00:02:22,033 --> 00:02:24,801 what would the treatment be? 62 00:02:24,801 --> 00:02:27,133 Treatment is usually surgery, radiation, or both :02:27,133 --> 00:02:29,501 There are side effects, like urine leakage :02:29,501 --> 00:02:32,467

13 And some men also experience impotence :02:32,467 --> 00:02:34,901 they can no longer get an erection :02:34,901 --> 00:02:37,634 Blood clots and heart attacks are much less common, 67 00:02:37,634 --> 00:02:40,767 but those are possibilities following any major surgery :02:40,767 --> 00:02:42,901 So what do you think about that? 69 00:02:42,901 --> 00:02:44,634 PATIENT: Those are some

14 serious side effects 70 00:02:44,634 --> 00:02:48,868 I would definitely like to avoid :02:48,868 --> 00:02:52,234 Well, if I was confident that a cancer was most likely harmful, 72 00:02:52,234 --> 00:02:54,067 I'd recommend treatment in most cases :02:54,067 --> 00:02:56,033 But if the cancer didn't appear to be harmful, 74 00:02:56,033 --> 00:02:58,934 there would be another option

15 called active surveillance :02:58,934 --> 00:03:01,334 Choosing this option could mean that you'd avoid 76 00:03:01,334 --> 00:03:04,100 the possible side effects of treatment :03:04,100 --> 00:03:05,167 Can you explain that option? 78 00:03:05,167 --> 00:03:06,534 DOCTOR: Sure :03:06,534 --> 00:03:10,033 We would keep a close eye on your prostate for a long time,

16 80 00:03:10,033 --> 00:03:12,100 by doing a PSA test every few months 81 00:03:12,100 --> 00:03:14,067 and repeating the biopsy from time to time :03:14,067 --> 00:03:16,801 maybe even doing an MRI of the prostate, too :03:16,801 --> 00:03:19,834 If the cancer grows, we'd reconsider treatment :03:19,834 --> 00:03:21,968 That sounds okay. 85

17 00:03:21,968 --> 00:03:24,934 But is active surveillance safe? 86 00:03:24,934 --> 00:03:27,000 We're still studying it, and there's a lot 87 00:03:27,000 --> 00:03:28,234 we don't know for sure :03:28,234 --> 00:03:29,701 There's some risk with active surveillance 89 00:03:29,701 --> 00:03:31,067 that cancer cells could spread 90 00:03:31,067 --> 00:03:34,067 before we see that the cancer is growing.

18 91 00:03:34,067 --> 00:03:36,334 At that point it might be too late for prostate surgery 92 00:03:36,334 --> 00:03:38,434 or radiation to cure the cancer :03:38,434 --> 00:03:39,634 So what do you think about this :03:39,634 --> 00:03:41,834 the active surveillance option? 95 00:03:41,834 --> 00:03:44,567 Well, I know I wouldn't want treatment unless 96

19 00:03:44,567 --> 00:03:47,033 you were sure I needed it :03:47,033 --> 00:03:48,934 If you found something and you were pretty sure 98 00:03:48,934 --> 00:03:52,267 it wasn't harmful, why get treatment 99 00:03:52,267 --> 00:03:54,334 that could cause those side effects? :03:54,334 --> 00:03:56,634 With active surveillance, you'd just watch it closely, right? :03:56,634 --> 00:03:58,367

20 That's right :03:58,367 --> 00:04:00,334 It sounds like active surveillance :04:00,334 --> 00:04:02,000 is something you'd consider :04:02,000 --> 00:04:04,067 That option is important for men to understand :04:04,067 --> 00:04:06,601 before they decide to get a PSA test :04:06,601 --> 00:04:08,601 So the first decision is the test?

21 107 00:04:08,601 --> 00:04:10,367 DOCTOR: Right :04:10,367 --> 00:04:12,434 Then there may be decisions after the test, :04:12,434 --> 00:04:14,968 like we've talked about, so it's important that you know :04:14,968 --> 00:04:17,501 about these things as you consider what's right for you :04:17,501 --> 00:04:19,434 You don't have to make a decision right now,

22 112 00:04:19,434 --> 00:04:21,067 but I'd like to know about your feelings :04:21,067 --> 00:04:23,100 about getting the PSA test :04:23,100 --> 00:04:26,667 I'm leaning toward getting it :04:26,667 --> 00:04:29,701 But I'm worried about winding up with side effects :04:29,701 --> 00:04:33,200 from treatment that doesn't end up benefiting me :04:33,200 --> 00:04:35,634

23 Do you recommend I get tested today? :04:35,634 --> 00:04:37,734 No, no-- I recommend patients do the test :04:37,734 --> 00:04:40,501 only if they're really sure it's right for them :04:40,501 --> 00:04:42,868 So for today, I suggest you take this information sheet :04:42,868 --> 00:04:46,167 with you-- it has answers to common questions that men have :04:46,167 --> 00:04:49,968

24 We can talk about it more when I see you in a couple of months :04:49,968 --> 00:04:51,167 Thanks :04:51,167 --> 00:04:54,267 I'll take a look and talk about it with my family, too :04:54,267 --> 00:04:55,300 That sounds good. 1 00:00:00,067 --> 00:00:11,767 2

25 00:00:11,767 --> 00:00:13,133 Okay, before we wrap up today, 3 00:00:13,133 --> 00:00:15,133 I'd like to talk to you about prostate cancer. 4 00:00:15,133 --> 00:00:18,300 You may know that African Americans and other black men 5 00:00:18,300 --> 00:00:21,801 are at a higher risk for prostate cancer than white men. 6 00:00:21,801 --> 00:00:24,234 And the risk increases starting at age :00:24,234 --> 00:00:27,033

26 So to give you an idea, about one in five black men 8 00:00:27,033 --> 00:00:29,234 will be diagnosed with prostate cancer in their lifetime. 9 00:00:29,234 --> 00:00:32,934 For one in 22 black men, it will be the cause of their death :00:32,934 --> 00:00:35,667 My grandfather had prostate cancer, so it runs 11 00:00:35,667 --> 00:00:38,267 in my family, too :00:38,267 --> 00:00:40,033 Your family history

27 probably puts you 13 00:00:40,033 --> 00:00:42,501 at somewhat higher risk, but not as high as it would be 14 00:00:42,501 --> 00:00:46,000 if you had a brother or a father with prostate cancer :00:46,000 --> 00:00:48,701 Here's the thing-- doctors don't all agree about testing :00:48,701 --> 00:00:50,901 There are pros and cons to the test :00:50,901 --> 00:00:52,868 Getting tested

28 every one to two years 18 00:00:52,868 --> 00:00:55,968 could reduce your risk of dying from prostate cancer 19 00:00:55,968 --> 00:01:00,400 by 20% to 30%, but the test can also lead to some harm :01:00,400 --> 00:01:02,534 For some men, not getting tested and avoiding the harm 21 00:01:02,534 --> 00:01:05,901 is the right choice, even though they lose a small benefit :01:05,901 --> 00:01:07,567 It's complicated,

29 so let's talk it through :01:07,567 --> 00:01:09,701 And we don't have to come to a decision today :01:09,701 --> 00:01:11,567 PATIENT: Okay :01:11,567 --> 00:01:14,067 DOCTOR: So PSA stands 26 00:01:14,067 --> 00:01:16,501 for prostate specific antigen :01:16,501 --> 00:01:18,834 The test for prostate cancer is a blood test that measures 28

30 00:01:18,834 --> 00:01:20,667 your PSA level :01:20,667 --> 00:01:23,067 A high PSA level might mean prostate cancer, 30 00:01:23,067 --> 00:01:24,734 but it could also mean 31 00:01:24,734 --> 00:01:27,434 things that aren't cancer, like an enlarged prostate :01:27,434 --> 00:01:28,968 Does this make sense so far? 33 00:01:28,968 --> 00:01:31,501 PATIENT: Yeah, I think so.

31 34 00:01:31,501 --> 00:01:35,234 Because we don't know for sure what's causing a high PSA level, 35 00:01:35,234 --> 00:01:37,067 we'd do more tests to find out :01:37,067 --> 00:01:39,567 If more tests showed that the likelihood of prostate cancer 37 00:01:39,567 --> 00:01:44,734 was high enough, then I might recommend a prostate biopsy :01:44,734 --> 00:01:47,834 So what would happen if the biopsy showed cancer? 39

32 00:01:47,834 --> 00:01:50,567 I would have surgery to remove it, right? 40 00:01:50,567 --> 00:01:53,033 I wish there was an easy answer to that, 41 00:01:53,033 --> 00:01:54,968 but not all prostate cancer is harmful :01:54,968 --> 00:01:57,701 The action we take would depend on how likely it is 43 00:01:57,701 --> 00:02:00,634 that the cancer we found will cause harm. 44

33 00:02:00,634 --> 00:02:04,501 But I thought all cancer was dangerous and could spread :02:04,501 --> 00:02:06,400 Well, unlike a lot of other types of cancer, 46 00:02:06,400 --> 00:02:08,267 most prostate cancers grow very slowly 47 00:02:08,267 --> 00:02:10,300 and won't cause problems or need treatment :02:10,300 --> 00:02:13,167 So treating these cancers could do more harm than good. 49

34 00:02:13,167 --> 00:02:15,601 But harmful cancers can spread, and treatment is needed 50 00:02:15,601 --> 00:02:17,267 to stop them :02:17,267 --> 00:02:19,267 The tough part is that we can't always tell 52 00:02:19,267 --> 00:02:21,701 which cancers are harmful and which ones would grow slowly 53 00:02:21,701 --> 00:02:23,267 and never need treatment :02:23,267 --> 00:02:28,033 If you did find the harmful

35 kind, what would treatment be? 55 00:02:28,033 --> 00:02:30,934 Well, treatment is usually surgery, radiation, or both :02:30,934 --> 00:02:33,701 There are side effects, like urine leakage :02:33,701 --> 00:02:35,701 Some men also experience impotence :02:35,701 --> 00:02:38,467 they can no longer get an erection :02:38,467 --> 00:02:41,067 Blood clots and heart attacks

36 are much less common, 60 00:02:41,067 --> 00:02:44,534 but those are possibilities following any major surgery :02:44,534 --> 00:02:46,400 So what do you think about these? 62 00:02:46,400 --> 00:02:48,334 I don't think those side effects are as bad 63 00:02:48,334 --> 00:02:49,667 as living with cancer :02:49,667 --> 00:02:51,934 I'd want to get treated and not have cancer in me.

37 65 00:02:51,934 --> 00:02:53,267 DOCTOR: Okay :02:53,267 --> 00:02:54,968 That's good for me to know :02:54,968 --> 00:02:57,934 If I was confident that a cancer was most likely harmful, 68 00:02:57,934 --> 00:02:59,868 I'd recommend treatment in most cases :02:59,868 --> 00:03:02,167 But if the cancer didn't appear to be harmful, 70

38 00:03:02,167 --> 00:03:05,000 there would be another option called active surveillance :03:05,000 --> 00:03:07,234 Choosing this option could mean that you'd avoid 72 00:03:07,234 --> 00:03:09,234 the possible side effects of treatment :03:09,234 --> 00:03:11,000 Can you explain that option? 74 00:03:11,000 --> 00:03:12,601 DOCTOR: Sure :03:12,601 --> 00:03:15,868 We would keep a close eye on

39 your prostate for a long time 76 00:03:15,868 --> 00:03:17,767 by doing a PSA test every few months 77 00:03:17,767 --> 00:03:20,167 and repeating the biopsy from time to time, 78 00:03:20,167 --> 00:03:22,601 maybe even doing an MRI of the prostate, too :03:22,601 --> 00:03:25,634 If the cancer grows, we'd reconsider treatment :03:25,634 --> 00:03:28,634 Is active surveillance safe?

40 81 00:03:28,634 --> 00:03:29,901 We're still studying it, 82 00:03:29,901 --> 00:03:32,133 and there's a lot we don't know for sure :03:32,133 --> 00:03:33,834 There's some risk with active surveillance 84 00:03:33,834 --> 00:03:35,067 that cancer cells could spread 85 00:03:35,067 --> 00:03:37,434 before we see the cancer is growing. 86

41 00:03:37,434 --> 00:03:39,834 At that point it may be too late for prostate surgery 87 00:03:39,834 --> 00:03:41,601 or radiation to cure the cancer :03:41,601 --> 00:03:43,434 So what do you think about this :03:43,434 --> 00:03:45,300 the active surveillance route? 90 00:03:45,300 --> 00:03:46,567 I know you said earlier 91 00:03:46,567 --> 00:03:49,501 that you wouldn't want cancer inside of you.

42 92 00:03:49,501 --> 00:03:51,300 Yeah, I don't think I'd want to wait to do something 93 00:03:51,300 --> 00:03:53,267 if I knew there could be harmful cancer inside of me :03:53,267 --> 00:03:54,434 DOCTOR: Okay :03:54,434 --> 00:03:56,033 Remember to keep in mind 96 00:03:56,033 --> 00:03:58,667 that just because you have a risk factor doesn't mean 97

43 00:03:58,667 --> 00:04:01,801 that we would definitely find harmful prostate cancer :04:01,801 --> 00:04:03,234 For every man who's been diagnosed 99 00:04:03,234 --> 00:04:05,133 by a PSA test and is cured, :04:05,133 --> 00:04:07, or more will have a prostate cancer diagnosed :04:07,300 --> 00:04:09,467 and will not benefit from treatment, :04:09,467 --> 00:04:12,667

44 usually because the cancer isn't harmful :04:12,667 --> 00:04:14,934 It's important for you to know before you do the test :04:14,934 --> 00:04:17,434 that if we did find cancer, and I was confident :04:17,434 --> 00:04:20,267 that it wasn't harmful, I may recommend active surveillance :04:20,267 --> 00:04:22,033 So does that make sense? :04:22,033 --> 00:04:23,701 Yeah, I see what you're saying.

45 108 00:04:23,701 --> 00:04:26,767 You want to be sure I understand what could come down the line :04:26,767 --> 00:04:28,033 before I decide about the test :04:28,033 --> 00:04:29,467 DOCTOR: Right :04:29,467 --> 00:04:33,100 But for now, the first thing to consider is the test :04:33,100 --> 00:04:35,200 Then there may be decisions after the test, 113

46 00:04:35,200 --> 00:04:37,501 like we've talked about, so it's good for you to know :04:37,501 --> 00:04:40,400 about these things as you consider what's right for you :04:40,400 --> 00:04:42,534 You don't have to make a decision right now, :04:42,534 --> 00:04:44,234 but I'd like to know how you're feeling :04:44,234 --> 00:04:45,801 about getting the PSA test :04:45,801 --> 00:04:47,834

47 I think I should probably get the test, :04:47,834 --> 00:04:50,901 especially since the prostate cancer's been in my family :04:50,901 --> 00:04:52,567 But I'm not sure about the active surveillance :04:52,567 --> 00:04:55,400 that you explained, and whether I'd be okay with that :04:55,400 --> 00:04:57,734 Would you recommend I get the test? :04:57,734 --> 00:05:01,334

48 I recommend patients do the test only if they're really sure :05:01,334 --> 00:05:02,734 it's right for them :05:02,734 --> 00:05:05,133 For today, I suggest you take this information with you :05:05,133 --> 00:05:08,267 It has answers to common questions men have :05:08,267 --> 00:05:11,267 We can talk about it more when I see you in a couple of months :05:11,267 --> 00:05:13,367 PATIENT:

49 Thanks. I'll take a look :05:13,367 --> 00:05:15,000 and talk about it with my family, too :05:15,000 --> 00:05:16,300 That sounds good.

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