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Better-Informed Decision-Making to Optimize Patient Selection

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Active Surveillance for Localized Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

Abstract

The journey of men diagnosed with low-volume, potentially non-aggressive prostate cancer may be a multifaceted one. In fact, from the moment of diagnosis, patients deal with the opportunity and burden of choosing among multiple therapeutic/observational strategies that differ in terms of clinical and personal costs and benefits. The treatment/active surveillance decision can be an initially counterintuitive one and feelings of disorientation could emerge. Based on existing literature and our experience within a multidisciplinary setting, this chapter aims to highlight how prostate cancer patients choose active surveillance and how clinicians and care staff can support men in making an aware choice. First, we introduce the main features that impact on the decision-making process and how they interact both at cognitive and emotional level. Then, we discuss the main barriers for men to choose active surveillance, including physicians’ pressures, family worries and individual sense of uncertainty. Information and shared decision-making – with physicians serving as co-drivers – both supported by the use of decisional aids, are discussed as milestones in the patients’ journey that can improve the selection in active surveillance, above all when active surveillance is presented within a multidisciplinary context. In order to approach patients starting from a collaborative and multidisciplinary approach, physicians need to step beyond their cultural and professional background and acquire adequate communication skills through ad hoc training programs. In conclusion, to improve patient selection in active surveillance, both the patients and the medical care staff need to shift to a perspective of collaboratively sharing their own perspective and experiences during the journey.

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Authors and Affiliations

  1. Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Lara Bellardita, Paola Dordoni, Letizia De Luca, Julia Paola Menichetti Delor & Riccardo Valdagni

  2. Radiation Oncology, Fondazione IRCCS IstitutoNazionale dei Tumori, Milan, Italy

    Riccardo Valdagni

  3. Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy

    Riccardo Valdagni

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  1. Lara Bellardita
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  2. Paola Dordoni
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  3. Letizia De Luca
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  4. Julia Paola Menichetti Delor
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  5. Riccardo Valdagni
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Correspondence to Lara Bellardita .

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  1. University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Laurence Klotz

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Bellardita, L., Dordoni, P., De Luca, L., Delor, J.P.M., Valdagni, R. (2018). Better-Informed Decision-Making to Optimize Patient Selection. In: Klotz, L. (eds) Active Surveillance for Localized Prostate Cancer. Current Clinical Urology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62710-6_14

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