Telling a patient he has prostate cancer

Today I've asked Professor Laurent Boccon-Gibod, Chief of urological surgery department of Bichat - Claude Bernard Hospital, Northern University Hospital Group (Public Hospital, XVIIIth district of Paris):

How do you tell a patient he has prostate cancer?

Professor Laurent Boccon-Gibod: "Patients are usually extremely aware of information related to prostate cancer. Telling a patient he has prostate cancer (Pc) is a process. The three steps of this process are:

1) Patients are informed that either the digital rectal exam (DRE) or the high amount of PSA (prostate specific antigen) in their blood has revealed a problem.

(Screening for prostate cancer can be performed quickly and easily in a physician’s office using two tests: the PSA (prostate specific antigen) blood test, and the digital rectal exam (DRE)).

2) They are informed that they will have to undergo a prostate biopsy, and a radiologist will perform an endorectal echography of their prostate.

(A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. For a prostate biopsy, a thin needle is inserted through the rectum - transrectal biopsy -, through the urethra, or through the area between the anus and scrotum - perineum. A transrectal biopsy is the most common method used. The tissue samples taken during the biopsy are examined for cancer cells).

The urologist starts evoking the possibility of a positive biopsy, preparing the patients for the next step.

3) Upon reception of prostate biopsy results, patients are informed that their prostate biopsy shows the existence of a malignant tumor and, taking into account the lesion profile, treatment options will be discussed.

In fact, breaking the news does not happen all of a sudden, it is a process that patients undergo with their urologist. The latter keeps them informed about the result of each exam/test; one step after another, the patient is being informed. In the end, he is told that indeed he has Pc, but at the same time he is informed that Pc is evolving very slowly, it is not an aggressive type of cancer. On hence patients are told their tumor will be evolving extremely slowly, that this is the way it is usually happening, with no – or quite few - impact on their life prognosis in the middle and in the long run. The advantage is that there is plenty of time to look into the treatment options, and to find out the best one."

==> website for healthcare professionals (prostate cancer): ProstateLine.com

==> French version for this Blog Post: click here.