What the prostate cancer patient should know: variations in urologists' opinions

OBJECTIVES: To determine the questions that treating Ontario urologists think should be addressed with patients who have curable prostate cancer before treatment decisions are made. METHODS: All Ontario (Canada) urologists (179) were given a scenario describing a case of curable prostate cancer and asked to judge the importance, using one of four categories (essential/important/no opinion/avoid), of addressing each of 78 questions. RESULTS: Ninety-seven (54%) of urologists completed the survey. The questions identified most frequently as "essential" to address were: treatment-related incontinence rates (76%), cure rates (74%), treatment-related impotence rates (73%), right of refusal (71%), and mortality from watchful waiting (63%). The questions identified most frequently to "avoid" related to searching for the first medical centre (29%) and the number of prostate cancer patients cured by the physicians (16%). There was little agreement among the urologists on the importance of addressing most of the remaining questions (Average agreement 40.7%). CONCLUSIONS: Most urologists assign great importance to addressing questions related to major treatment morbidity and success rates. Beyond these few major categories, there is widespread disparity among urologists about what information the patient should know. This "information gap" presents an identifiable dilemma in our adherence to the ethical principles underpinning informed consent in patients with potentially curable prostate cancer.