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Prostate terminology bewilders many inner-city men

By Kathryn Doyle

NEW YORK (Reuters Health) - Many inner-city men don't understand basic terms having to do with the prostate, according to a new survey, which could make it difficult for them to decide on treatment options for related cancers.

"The risk to benefit ratio of prostate cancer screening and treatment depend a lot on patient preferences, so it is critical that patients can understand the tradeoffs that are involved," said Dr. Stacey Loeb, a urologist at NYU Langone Medical Center in New York.

"This is particularly true for high-risk groups such as African Americans, who are known to be at greater risk for aggressive prostate cancer," Loeb, who was not involved in the study, told Reuters Health.

Another study this year indicated that the educational materials and websites doctors direct patients to are still too difficult for many patients to understand (see Reuters Health story of May 20, 2013 here: http://reut.rs/11cXHeQ).

Prostate cancer is the second leading cause of cancer death for men in the U.S., killing about 30,000 men each year according to the Centers for Disease Control. It's not always aggressive, however, meaning that men may be subjected to surgery or radiation, and side effects, without necessarily extending their lives.

Researchers distributed "pop quiz" surveys on common terms related to urinary, bowel and sexual functions at two clinics for low-income patients.

Of 109 men, 95 percent did not understand what the prostate does, according to results published in the journal Cancer. The numbers were better but still low for terms like "incontinence," "urinary function" and "bowel habits."

Many of the men read at a 9th-grade level.

"As our results indicate, most physicians likely overestimate patient understanding of these terms," coauthor Dr. Ashesh Jani told Reuters Health by email.

Prostate cancer can be confusing even for men with high literacy, said Jani, a radiation oncologist treating prostate cancers at Winship Cancer Institute of Emory University in Atlanta.

These results are "exactly what I would expect," according to Dr. Mack Roach, chair of radiation oncology at the University of California, San Francisco Medical Center.

But he's not necessarily worried about the patients as long as they're cared for by quality doctors, said Roach, who was not involved in the study.

"Allowing (patients) to feel comfortable about asking questions is most important, but this depends on the doctor," Roach said.

"For practicing clinicians, this is very important information," Dr. Durado Brooks of the American Cancer Society in Salt Lake City, Utah, told Reuters Health.

He found the numbers in this study "a little shocking," and stressed that doctors need to assess how much a patient understands, since some are embarrassed by their lack of knowledge.

Patients with low knowledge levels could jeopardize the patient half of "shared decision making," the collaborative process between patient and physician to come to a treatment decision, Loeb said.

"However, it is important to note that most of the men in this study did not have prostate cancer," she said. "Many people without any previous knowledge about a medical problem will read up on it if they are diagnosed."

SOURCE: http://bit.ly/13iQ0TK Cancer, online June 3, 2013.

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