The Communications Game

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As a profession, doctors are notoriously bad communicators.  Patients complain that after seeing their doctor they come out of the consulting room and have no real idea of what is wrong with them or what caused the problem.

And that scenario is not just here in Thailand where either the doctor or the patient is having to speak in a ‘foreign’ language, but is true for Australian patients with their Australian doctor, and likewise for UK patients with their native English speaking doctor.

I was reminded of this the other day, when a chap with prostate cancer saw me wanting to discuss his medical situation.  “Am I stage 1, stage 2, stage 3 or stage 4?” he asked.  He had plenty of results, had seen local doctors, hospital doctors, cancer hospital doctors and he was just as much in the dark as he was when first diagnosed.

Of course, staging prostate cancer can be confusing.  The Prostate Specific Antigen levels (PSA) are only a guide.  There is also the simple four stage typing.  Then there are other scales such as the TNM (tumor, node, metastases) and yet another called the Gleason score.  With all those complications it is no wonder patients get confused.

I dealt with prostate cancer a few months ago, but it is obvious I should touch on the subject again.  Firstly, is prostate cancer rising?  Not really.  One reason for the ‘apparent’ increase in prostate cancer is the fact that prostate cancer is a disease of aging, and we are all living longer.  The statistics would show that by age 50, almost 50 percent of American men will have microscopic signs of prostate cancer.  By age 75, almost 75 percent of men will have some cancerous changes in their prostate gland.  Do the math.  By 100 we’ve all got it!

So does this mean that life really ends at around 76?  Fortunately no.  Most of these cancers stay within the prostate, producing no signs or symptoms, or are so slow-growing, that they never become a serious threat to health.

While the numbers quoted above look fearsome, the real situation is not quite so bad.  A much smaller number of men will actually be treated for prostate cancer.  About 16 percent of American men will be diagnosed with prostate cancer during their lives; 8 percent will develop significant symptoms; but only 3 percent will die of the disease.  Put another much more positive way, 97 percent won’t die from prostate cancer.  This means I must be OK, as my three friends with prostate cancer hopefully make up the three percent of my acquaintances.

However, the great majority of prostate cancers are slow growing, and it can be decades between the early diagnosis and the cancer growing large enough to produce symptoms.

So let’s look at diagnosis and get the “blood test” out of the way first.  Unfortunately, PSA is not a go-no go test.  Serial PSA examinations can show the rate of growth, another good reason for regular check-ups.

Like many other cancers, prostate cancer can only be fully diagnosed by examining prostate tissue samples under the microscope.  When your doctor suspects prostate cancer on the basis of your symptoms, or the results of a clever finger rectal examination (DRE), and/or a PSA test – the definitive diagnosis will need a biopsy.

So let’s imagine that now you have had a positive biopsy.  You’ve got it!  What are the real options?  Actually very many and depend mainly upon the ‘stage’ of the cancer and your age at the time of diagnosis.

Simple ‘Staging’ has four main grades.  Stage I cannot be felt and is diagnosed through pathological testing.  Stage II can be felt, but it is confined to the prostate.  Stage III is coming out of the gland and Stage IV has grown into nearby tissues.

Treatment can be ‘watch and wait’, surgery, radiation, and hormone therapy.

Watch and wait has much going for it, but you must be prepared to get to know your urologist on first name terms.  You will be seeing a lot of him over the years, so pick a young one with good English!  Medical communication can be something of a minefield.