The management of prostate cancer is complex and often confusing for both the patient, his family and the medical and health practitioners involved in his care.
The complexity is due to a range of factors including the biological evolution of prostate cancer, the difficulties arising from the lack of a specific and sensitive non-invasive test that can provide early diagnosis and predict the subsequent progression of the disease. Further, many of the treatment modalities are associated with side effects that can significantly influence the quality of life of the patient. In some instances, the lack of properly controlled clinical trials has resulted in the absence of an evidence base on which to select the best treatment for each patient.
These clinical practice guidelines have been developed following an extensive analysis of papers that can inform the decision making process for the patient, his family and those involved in managing his care. The results of these analyses have been reviewed by the Working Party of the Australian Cancer Network with further support from the Cancer Council Australia. The recommendations encompass the range of treatment modalities and include psycho-social care, complementary and alternatives therapies and the socioeconomic aspects of advanced prostate cancer.
One of the major strengths of this set of recommendations is that it provides the reader with an assessment of the quality of the evidence on which they are based. This enables all concerned in the patient’s management to assess the risk-benefit ratios for the range of modalities concerned. The educational value of this document is very high and will assist the decision makers in their difficult decisions. It also sets out the needs of this area of medicine and it challenges all those concerned to continue the search for the best management of the patient and enables the patient to have an involvement in this challenging activity.
I congratulate all involved in this extensive process and hope that the value placed on this document will be some recompense for their work in making this happen.
Monash University, Clayton, Victoria, Australia