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Authors Kirkman M, Young K, Evans S, et al.
Review Date November 2017
Citation BMC Cancer 2017; 17:704
Prostate cancer survival is generally good in Australia. However, there are specific groups of men for whom survival is not as good. Data from the Victorian Prostate Cancer Registry showed three were differences in care and poorer rates of survival for men diagnosed with prostate cancer in one Victorian regional area (5-yr survival = 86%) compared with men in metropolitan Melbourne (5-yr survival = 93%). Men in this regional area are more likely to be diagnosed at an older age with more advanced disease and have a longer interval between diagnosis and treatment. Gaining an understanding of the experiences and perceptions of men with prostate cancer in regional and metropolitan areas could help to explain the observed regional differences.
The authors sought to explore the perceptions and experiences of prostate cancer diagnosis, treatment, and care of men diagnosed with prostate cancer who lived in regional or metropolitan areas. Men who had not been diagnosed were also included in the study, to explore possible pre-diagnosis or pre-treatment barriers that may exist in the community.
This was a qualitative study involving in-depth interviews to explore explanation and meaning. Twenty-one men were interviewed: 10 were recruited through the Prostate Cancer Outcome Registry-Victoria and 11 from the community. Transcripts were analysed thematically. Each interview began with a request to de- scribe ‘your experiences of prostate cancer’ (men who had been diagnosed) or to describe ‘anything at all … that you have experienced of prostate cancer’ (men who had not been diagnosed). The interviewer pursued matters identified by the men as important, with prompts, if necessary, that included consulting a GP, the process of diagnosis, and medical care. At the conclusion of the interview, men were asked what advice they would give to other men, doctors, and policy makers about prostate health.
Four main themes related to how men discussed prostate cancer were identified: Case-finding (detection of asymptomatic prostate cancer), Diagnosis, Treatment and Care, and Spreading the Word.
Men were generally aware that prostate cancer was an important health problem and reported that publicity about prostate cancer acted to prompt them to ask the GP about testing. Men in metropolitan areas typically had prostate cancer testing during a medical check while those in regional areas reported having a test at the recommendation of the doctor while undergoing treatment for another condition (diagnosed men) or requesting a test from the GP after becoming aware about prostate cancer and testing (undiagnosed men). Some men reported GPs being reluctant to test due to changing guidelines.
Men often reported that biopsy was a difficult process and some thought there was inadequate support for them during the time to diagnosis. Men from metropolitan areas said the wait to diagnosis was made bearable by the support from healthcare providers but men in regional areas were more likely to cite a lack of support.
Treatment and Care
Men from metropolitan areas spoke of careful treatment decision-making ‘working together’ with their doctor and from the various sources of information particularly valued learning about other people’s experiences. On the other hand, men from regional areas were more likely to report making a decision ‘on the spot’, at the time of diagnosis or soon after, on the advice of the doctor.
Men from metro areas described their experiences of side effects of treatment as a step towards a return to health while regional men’s accounts related more to ‘acceptance’. Men who did not have prostate cancer from metro areas discussed side effects they had heard about and that some men feel the side effects may outweigh the benefits of the treatment; however side effects were not brought up by undiagnosed men from regional areas.
Men generally valued their GPs, especially those who were ‘proactive’ about specific health matters rather than taking a ‘wait and see’ approach, and who were ‘reliable’, ‘careful’, ‘professional’, and a ‘good listener’. Most men appreciated the care they received in hospital, frequently mentioning the kindness of staff. Although not often mentioning mental health issues specifically, more general comments suggested that men feel that support for mental health should be integrated at all levels of care.
Men diagnosed with prostate cancer reported actively discussing their experiences with other men willing to listen. When asked if they had advice for men about prostate health, they thought men should be tested at an annual check-up and when with some suggesting an initial PSA test to establish a baseline PSA level. Advice to men was to take it (prostate health) seriously but not to panic.
Comparisons between responses of men from regional and metropolitan areas related mostly to the more limited supportive care available in regional areas.
From a more general perspective, it was evident that every aspect of prostate cancer care would benefit from attention, from making efforts to publicise the need for men to check prostate health, to treatment, and supporting men in the years after treatment. Continuing to work on systemic improvements is an important goal for all those committed to men’s health, particularly with respect to improving access to health care and support in regional areas.
Points to Note
- Comparisons between men from regional and metropolitan areas highlighted the more limited support available in regional areas.
- Participant’s concerns about clinical guidelines and case finding support evidence that conflicting guidelines may contribute to GPs’ inconsistent approaches.
- Minimising the waiting time between biopsy and diagnosis is particularly challenging in regional areas where specialists’ visits may be infrequent.
- It was apparent that the men value the support of their partners and peers, suggesting that there could be more focus on making opportunities for men diagnosed with prostate cancer to talk with others previously diagnosed.
- Men were clear that information is needed at all stages of the prostate cancer journey.
- Although not an inclusion criterion, participants appeared to be heterosexual; gay men’s experiences of prostate cancer may differ from those reported here.