If you have not heard about Patient Navigation and Nurse Navigators, the first Patient Navigation Program was established in Harlem New York in 1990 to address the dramatic differences in death rates from breast cancer among minority women in the community. Dr. Freeman who pioneered this program found among other things that poor people meet significant barriers when they attempt to seek diagnosis and treatment of cancer. They also experience more pain, suffering, and death because of late diagnosis and treatment at an incurable stage of the disease. The introduction of Patient Navigation led to an increase in the 5 year survival(number of people alive 5 years after their diagnosis of cancer) of breast cancer patients from 39 percent to 70 percent. Since then Patient Navigation programs have been developed for many different types of cancer including prostate cancer. Today there are Nurse Navigators like myself, specially trained in cancer care, ready to help guide you on your journey from an abnormal finding to a resolution and survivorship (having no sign of cancer after treatment or living with, through and beyond cancer).
A nurse-led shared-care prostate clinic is a cost-effective,thorough and speedy method of assessing patients presenting with LUTS (Lower Urinary Tract Symptoms) due to suspected bladder outflow obstruction. Bottom line, “we need more of them”. They provide faster service, comprehensive initial assessment, quicker streamlining of referrals, better targeting of resources (that continue to diminish), better education for patients and improved communication among healthcare providers. These clinics also offer an opportunity to increase the numbers of specialist nurses. General practitioners and urologists have expressed satisfaction with these clinics.
There are problems with over-diagnosing and over-treating prostate cancer. Many men for example may have a cancer that may not cause them any problems in their lifetime. Here is one report that addresses this.
Today a growing number of doctors are questioning the value of using any single PSA(Prostate Specific Antigen) blood test result as well as a cut-off(maximum allowed result) of 4ng/ml in determining whether a man is at risk for prostate cancer. In the Prostate Cancer Prevention Trial, 7 percent of men who had a result below 0.5ng/ml had prostate cancer and 12 percent of these men had the aggressive life threatening form of the disease. One answer being used today is the use of Nomograms, scientific formulas using more information about prostate cancer to determine a man’s estimated risk of having the deadly form of the disease. For men who would like to avoid the DRE (Digital Rectal Examination), the Sunnybrook Hospital Prostate Risk Calculator may be of interest.
For the benefits of prostate risk assessment tools click here
Listen to Dr Robert Nam talk about the Sunnybrook Hospital prostate risk calculator