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Communicating prostate cancer risk: what should we be telling our patients?
Author(s) -
Baade Peter D,
Steginga Suzanne K,
Aitken Joanne F,
Pinnock Carole B
Publication year - 2005
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2005.tb06790.x
Subject(s) - prostate cancer , medicine , family history , population , cancer , risk perception , disease , prostate , risk assessment , gynecology , family medicine , intensive care medicine , perception , psychology , surgery , environmental health , computer security , neuroscience , computer science
Until definitive evidence of the effectiveness of prostate cancer screening is available, most guidelines advocate that men make their own decisions about testing, after being fully informed. A man's perception of his personal risk is a key element in the decision‐making process. In this decision‐making, the current routine use of population risk estimates may be misleading. Risk estimates need to be relevant to the man making the choice. In particular, they should be age‐specific and, where possible, include adjustments for known risk factors such as family history. As an example, although the population risk of lung cancer mortality is twice that of prostate cancer, for a non‐smoking man with a family history of prostate cancer the direction of this comparison would be reversed. A man aged 50 diagnosed with prostate cancer has a greater likelihood (60%) of dying prematurely (before 80 years) from prostate cancer than a man diagnosed when aged 70 (38%). This can be attributed to the longer time available for the prostate cancer to progress, and the increased effect of competing causes of death among older men. This suggests that the oft‐used statement “men are more likely to die with prostate cancer than from prostate cancer” is misleading, particularly for men diagnosed in their 50s or 60s. Decisions need to be made by men based on the best possible understanding of their personal vulnerability, and the individualisation of risk provides a more realistic appraisal of potential threat posed by the disease.