Close-ups

A Patient's Perspective

Hard Decisions About Prostate Cancer

Am Fam Physician. 2014 Feb 1;89(3):219.

I was devastated when the oncologist confirmed my diagnosis of prostate cancer. My family doctor had prepared me for the possibility. She was suspicious when she found blood in my urine. I also had an elevated prostate-specific antigen level on tests that were done at another clinic, which had not been brought to my attention. My doctor explained that this finding was serious and needed to be “worked up” so we could make sure I didn't have prostate cancer. I was tempted to run away and ignore the whole thing, but her listening and saying that she cared helped me overcome my fear and agree to see the oncologist.

Overwhelmed with the various treatment options and their risks and complications, I had a long discussion with my family doctor, ultimately deciding to have a radiation implant placed directly into my prostate. There were many difficulties that followed over the next year, including agonizing pain, persistent infections, and debilitating nausea. Getting through this ordeal required special and expensive medications that my health insurance company was reluctant to cover. My doctor worked tirelessly to get approval for the medications that I needed, which I so appreciate.

Despite the setbacks and unexpected complications, I never felt alone. I see why they call my doctor a family doctor, because she treats me like a family member. She guided me through painful times by returning my calls, listening to my concerns, and helping me deal with changes in sexual functioning that followed the surgery. She's also been a big help for my family in responding to their questions and fears about the surgery and addressing my worries postcancer.

My cancer has been in remission for three years now, and when fear of the cancer returning pops up, I remind myself that I can count on my “family” doctor.—L.S.

COMMENTARY

This story underscores the benefit of the physician-patient relationship in dealing with the complexities of prostate cancer diagnosis and treatment, especially when evaluating results of laboratory tests done elsewhere. Family physicians must be diligent in reviewing the medical history of new patients and their medical records from prior clinics to verify that patients are aware of any abnormalities in their records that may need further investigation. Family physicians are also important in helping a patient navigate the medical system when referred to subspecialists and advised to have further diagnostic procedures or treatments. Patients should be able to set personal treatment goals within the context of viable options offered, and a family physician can help in meeting those goals through education and collaboration with subspecialists.

RESOURCES

Cancer-Pain.org: http://www.cancer-pain.org

Prostate Cancer Foundation: http://www.pcf.org

Us TOO International Prostate Cancer Education and Support Network: http://www.ustoo.org

Close-ups is coordinated by Caroline Wellbery, MD, Associate Deputy Editor, with assistance from Amy Crawford-Faucher, MD; Jo Marie Reilly, MD; and Sanaz Sara Majd, MD. Questions about this department may be sent to Dr. Wellbery at afpjournal@aafp.org.

A collection of Close-ups published in AFP is available at http://www.aafp.org/afp/closeups.

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.


Copyright © 2014 by the American Academy of Family Physicians.
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