Editor’s Note
	Doctors with cancer

When our CME group prepared to launch this series almost three years ago, our first task was to read and listen. The clinicians who comprise our content team have considerable experience in cancer education, but in planning new programs we always seek to understand the most controversial and problematic questions that occur in translating emerging research data into practice for each unique tumor type.

Our initial perusal of the prostate cancer literature quickly provided a plethora of highly challenging management issues, many of which are being addressed in ongoing clinical trials. Two of the most provocative are discussed by the speakers on this program — watchful waiting in very early stage disease and management of PSA relapse.

When I asked Peter Carroll what he believed was the single most important area of future clinical research in prostate cancer, he immediately zeroed in on the patient with very early stage disease. By contrast both Matt Smith and Arif Hussain commented on the numerous questions about management of biochemical relapse. Dr Smith reviews his landmark research on the secondary effects of androgen deprivation and Dr Hussain presents new data on the potential role of chemotherapy in this situation.

While a great deal of optimism surrounded the launch of this series, our group’s interest in these and other prostate cancer controversies was considerably increased by two extraordinary events in the first few months of the project. First, a 42-year-old member of our staff, who visited a physician for a routine check-up, arrived at work the next day pale and shaken.

Unbeknownst to him, and without a precipitating family history, a PSA had been drawn and was found to be minimally elevated. After a couple of weeks of indecision, he agreed to extended pattern prostate biopsies, one of which showed Gleason 6 disease in 2 percent of one core.

He was advised to have a radical prostatectomy but declined, and currently more than two years later, his PSA is 1.7 ng/mL, he feels well, and he has not been rebiopsied. Every man in our office now routinely clarifies the specific tests to be done on any blood sample because we have observed first hand — for better or worse — the implications of a PSA assay.

The other experience was even more eye opening. To better understand issues in prostate cancer, we invited about a dozen research leaders — over a period of several months — to spend a day with our CME team in Miami as “visiting professors.” One of the first visitors was a quiet, unassuming, tanned, very kind and pleasant urologist whose CV was filled with numerous important publications.

As I shared coffee with Dr Paul Schellhammer, he casually mentioned that after a career in prostate cancer clinical research, he had been diagnosed with the disease 18 months previously and was treated with radical prostatectomy. At the time of the interview Paul had just learned that his PSA level was increased and he was sifting through treatment options.

I hesitantly asked if he would be willing to share his experiences with our national audience of listening physicians by telling his story on a recorded interview. Paul agreed without hesitation, and what followed was one of the most edifying educational experiences of my career.

Because of the many emails and comments we received about Dr Schellhammer’s interview, I met with him again more than a year later. At that point, he had completed regional radiation therapy and eight months of complete androgen blockage with bicalutamide and goserelin, a regimen he has studied extensively.

Paul’s clinical experience with thousands of men with prostate cancer did little to prepare him to walk in the shoes of his patients. During the initial interview, he spoke about the intense concern he experienced about potential clinical progression and the appeal of unproven and potentially toxic treatment options like chemotherapy.

In the second interview, he verbalized his surprise at the extent of morbidity with radiation therapy, and how these symptoms affected his lifestyle. He also described subtleties of cognitive impairment with androgen ablation that had not been reported in clinical trials.

Two more related experiences over the next couple of years convinced our group that there was a very valuable yet untapped resource in continuing medical education. Another visiting professor, medical oncologist Dr Mary Ellen Taplin, confided in the middle of the interview that her husband was diagnosed with a brain tumor. Dr Taplin noted that while seeking opinions at four major referral centers, she and her husband received four very different treatment recommendations. Dr Taplin also related how differently she now perceives the experience of the family members of cancer patients.

Finally, after spending considerable time reviewing the evolution of her research on locally advanced prostate cancer, a more recent “visiting professor,” radiation oncologist Dr Colleen Lawton mentioned that her father had been recently diagnosed with the disease.

Most remarkably, Dr Lawton’s father had developed locally advanced prostate cancer and received (from another physician) the same therapy his daughter had a central role in developing. During the interview, Colleen eloquently elaborated on her experiences on the “other side of the stethoscope.”

While driving home from my interview with Dr Lawton, I reflected on the profound challenge every doctor faces in attempting to understand the patient’s perspective.

I was struck by the potential impact of gathering and disseminating information about the perspectives of physicians who have had a personal experience with specific illnesses. Below you will find details of a unique project we are launching to explore this fascinating area. Your assistance will be much appreciated.

—Neil Love, MD

Patient and Physician Perspectives on Screening and Treatment of Prostate Cancer

Chan EC et al. Physician perspectives on the importance of facts men ought to know about prostate-specific antigen testing. J Gen Intern Med 2003;18(5):350-6. Abstract

Cohen H, Britten N. Who decides about prostate cancer treatment? A qualitative study. Fam Pract 2003;20(6):724-9. Abstract

Hilsman WJ. Deciding on radiation therapy: A patient’s perspective. Semin Urol Oncol 2000;18(3):200- 4. Abstract

Love N et al. How do prostate cancer survivors perceive treatment trade-offs for hypothetical clinical situations? Poster, 2003 American Urological Association Meeting.

Lubeck DP et al. A review of measurement of patient preferences for treatment outcomes after prostate cancer. Urology 2002;60(3 Suppl 1):72-7; discussion 77-8. Abstract

Slevin ML et al. Attitudes to chemotherapy: Comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 1990;300(6737):1458-60. Abstract

Taylor KL et al. Impact of undergoing prostate carcinoma screening on prostate carcinoma-related knowledge and distress. Cancer 2002;95(5):1037-44. Abstract

Wegner RE. Deciding on radical prostatectomy: A patient’s perspective. Semin Urol Oncol 2000;18(3):192-9. Abstract

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Editor’s Note:
Doctors with cancer

Peter R Carroll, MD
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Matthew R Smith, MD, PhD
    - Select publications

Arif Hussain, MD
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