Nearly nine out of 10 healthy men say maintaining their lifestyle is the main priority if they had to receive a hormonal treatment for locally advanced prostate cancer, according to a new study.1 In reality, nearly half of men feel that they are not asked about their lifestyle preferences when discussing treatment options and their effect on quality of life, as results from a new patient survey show.2 In contrast, more than three quarters of women with breast cancer are likely to be asked about their lifestyle preferences when discussing treatment options.2

The study involved 180 healthy men, aged 50 years and over, who were given scenarios describing the details of the two types of hormonal therapies used in locally advanced prostate cancer - either a luteinising hormone releasing analogue (LHRHa), or a non-steroidal anti-androgen (NSAA), such as bicalutamide 150mg - together with a discussion on their side effects. They were then interviewed and asked which type of therapy they would prefer if they were diagnosed with locally advanced prostate cancer.

Professor Lesley Fallowfield, one of the study researchers and Director of Cancer Research UK's Psychosocial Oncology Group, Brighton and Sussex Medical School, says: "These results suggest that men with locally advanced prostate cancer should be offered not just a choice of treatment but an explanation of how the treatments are given and the impact that their side effects may have on men's lifestyles."

Most men would prefer a hormonal therapy that allows them to maintain their lifestyle by avoiding undesirable side effects, such as reduced physical strength and increased risk of bone fractures. Nearly nine out of 10 men say they would prefer NSAA therapy (compared with less than one in 10 choosing an LHRHa), because of a better side effect profile (three quarters of respondents).

Patients with locally advanced prostate cancer have a significant risk of their disease progressing, seriously impacting quality of life. Therefore therapies that improve progression-free survival whilst allowing patients to maintain a normal lifestyle are vital in managing the disease. It has been shown that when patients' are given the advantages and disadvantages of alternative treatments, they are willing to contemplate trading life expectancy to be relieved of the burden of side effects, such as limitations in physical energy.3

In addition, results from the patient survey show the need for physicians to involve men more when deciding on the choice of treatment. The comparative survey of prostate (n=87) and breast (n=104) cancer patients currently receiving hormonal therapy aimed to look at the differences in behavioural and attitudinal approaches that men and women have towards their disease and its treatment. Findings show that just over half of men with prostate cancer are likely to be asked about their lifestyle preferences by their physician in stark contrast to four out of five women with breast cancer when treatment options are being discussed.2

"Although men are traditionally less likely to talk about illness, especially their own," says Professor John Masters, Executive Director, the Prostate Cancer Research Centre, University College, London. "These findings show us that not enough is being done to address men's concerns over side effects of prostate cancer therapies and their impact on lifestyle. Patients need to be involved in the treatment decision process to ensure that they receive the best treatment choice in terms of lifestyle and quality of life."

Even though nearly two thirds of men with prostate cancer experience side effects with hormonal therapies, less than one in five is willing to discuss the possibility of changing treatment to reduce side effects, compared with more than a third of women with breast cancer.2

Mr Geoffrey Mitchell, a 59-year-old grandfather of three, says that men need to be bolder when it comes to challenging their physicians about treatments and actively seeking more information about their illness. "When I was first diagnosed with prostate cancer, I felt it was very much a case of 'doctor knows best'. Also, the worry of first being told you have cancer meant I couldn't really think straight at the time. Fortunately, my doctor discussed all the options in detail and we both agreed the most suitable drug for me. The last thing I wanted was to have to give up my active lifestyle and work. We both agreed that I needed a treatment which would mean I could still carry on at work and be there for my children and grandchildren."

The findings from both the preference study and patient survey reinforce the need to offer patients with locally advanced prostate cancer a choice of treatment options, and for physicians to discuss these not only in terms of achieving an effective outcome but also how their side effects will impact on men's lifestyles and physical activities.

Each year around 30,000 men in the UK alone are diagnosed with prostate cancer, which has overtaken lung cancer to become the most common cancer for men in the UK. Prostate cancer is the second biggest cause of death from cancer in men in the UK with around 10,000 deaths each year and more than 80 per cent of cases are diagnosed in men over 60.4

When the prostate cancer has spread into the capsule of the prostate or through the prostate into the surrounding tissue, it is described as being 'locally advanced'

The preference study involved 180 men aged over 50. Research was conducted by the team at Cancer Research Psychosocial Oncology Group, Brighton and Sussex Medical School, headed by Lesley Fallowfield. The authors were in receipt of an unrestricted educational grant from AstraZeneca Oncology

Bicalutamide 150mg is a non-steroidal anti-androgen, indicated for locally advanced prostate cancer as immediate therapy either alone or as adjuvant to treatment by radical prostatectomy or radiotherapy. Bicalutamide 150mg monotherapy offers an alternative treatment, when surgical castration or other medical intervention is not considered appropriate

The oncology survey was supported by an unrestricted educational grant from AstraZeneca Oncology UK

The Prostate Cancer Research Centre is an organization which researches into the treatment and cure of prostate cancer and provides patients with information on treatments available