Telling someone they have prostate cancer

One of the most difficult things that a urologist has to do is to tell his patient that he has cancer. I recently had a somewhat heated debate with my partner in robotic surgery.
Prostate cancer is the leading solid organ cancer in men and is diagnosed by a biopsy in the office. The reasons for a biopsy are given by the urologist when scheduling the procedure and the urologist is present for the biopsy.
I have had discussions with my partners about the two main ways of doing this for prostate cancer and there is a difference in opinion. The two ways are over the phone or face to face.


The first way that it can be done is to have the patient come back for an office visit and go over the results in person.
The advantages of this are:
The patient is with you and can be comforted in a controlled setting.
The patient can have ample time to accept the news and immediately ask questions.
The disadvantages are:
The patient will have to wait longer for the results.
The first reaction is often shock, and the consultation for the treatment options that is to follow may not be remembered.
The second way is to give the patient the news over the phone:
The advantages of this are:
The patient will have a minimum time to wait to obtain the results.
The patient will have time to absorb the information and will be better prepared for the consultation of treatment options that is to follow.
The disadvantages are:
The patient will have to wait to meet you to go over all the options for treatment.
The patient may not have as much support at home.
Please vote on what you would prefer and add comments below specifying if you are a physician or a patient that has had to deal with this.
My thought on this will be added as a comment.
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23 Responses to Telling someone they have prostate cancer

  1. Bob Bartkowicz says:

    I think the “face to face” is better. Based on my experience, before I went to the urologist after my biopsy, I expected the worst. (prostate cancer) But even after he confirmed it, I probably went into a depression shock, & that is probably normal. I would like to make a small suggestion though.
    When the patient comes in for his results, tell him that you have “bad news & good news” for him. While he is listening to the “bad news” (to which like me, probably thought that he had the cancer before the visit) He may be thinking “What possible GOOD news is there”. That’s when the doctor can tell him that his cancer is not that bad, (in most cases) & that the treatments have really progressed & that new procedures are being tested as we speak. One of them is the LAP. For instance, when I was diagnosed, the LAP wasn’t available. If I didn’t enroll in the HIFU trial, I would have had something done from a list of options that I wasn’t thrilled about. I also think that the doctor should tell the patient that whatever treatment he decides, he should be able to talk to a former patient who had that particular treatment whatever it may be. That would have to be set up by you. Oh, one more thing, he should be told that PC is a slow mover & to take his time & make the “right” choice for him.
    any questions…. contact me..Bob

  2. Lee Pressler, MD says:

    I let them know the results over the phone and then set up a face to face meet with the patient and his wife. This gives them a few days to do some research on the internet and I find the face to face meeting more meaningful if they have some prior knowledge of the disease.

  3. I have been in practice 3 years and I have always tried to give the biopsy results over the phone.
    This may seem cold, but with prostate cancer it is rarely a surprise. Prostate biopsies are scheduled during an office visit when an elevated PSA or abnormal prostate exam is found.
    At this point, I tell the patient what their chance of having prostate cancer is based on the PSA value, previous PSA values, and the prostate exam.
    During the prostate biopsy, which is also done in the office with only local anesthesia we discuss prostate cancer again and I assure the patient that this is almost always curable. I explain to him that if its OK with him, I will call him with the results in the evening and explain what we found.
    I also schedule an appointment for 1 week after the biopsy to go over the options.
    I am aware that people may agree to this even though they might prefer to get the results in person.
    I hope to learn what patients and other docs think of this.
    I may put together a questionnaire for patients and have them decide how they would like to receive the news.

  4. Jim Davenport says:

    I was first diagnosed with PC 9 years ago, by telephone, and was able to see the urologist the next day. I had seed implants in Phoenix. After 8 years, I kinda dismissed it from my mind.
    In January of 2005, the VA again called to tell me that my psa was rising.
    Perhaps I am not like a lot of other patients, but I prefer the telephone diagnosis, as it gave me time to think out questions before the office visit.
    Another thing, who would really be surprised to hear that they have cancer, after a biopsy?
    I suppose that I am a hard headed realist. I was not surprised.

  5. Oskar Tang says:

    The answer to the question depends on what the patient prefers.
    The best time to reduce the shock is before it is confirmed. On the recommendation of a biopsy, let the patient to comtemplate the possibility that he may have the cancer and explain to him, if he has it, what treatment options may be available. Then ask him how he would like to receive the result. If it is positive, he is already prepared. If it is negative, he is happy and the emotional journey will have a positive impact on his life.

  6. Michael Koch says:

    Since 3/4’s of biopsies are negative, I think you are wasting most peoples’ time to bring them back in to hear that a biopsy is negative. I think calling is fine for those with positive biopsies as long as it is followed fairly quickly by a face to face visit in the office and as long as you take the time on the phone call to reassure them and answer all of their questions.

  7. gmm says:

    Just make sure that your receptionist is kind enough, when the patient phones for results, not to tell them they can just wait because the person they have called is too busy. That sucks!

  8. James Sloan says:

    I tell pts over the phone and have them come in within the week to discuss implications and options. During the call I usually inform them of the slow growing nature of the disease and life expectancy even without treatment.

  9. Rick Simmons says:

    I notify patients by phone as soon as the results are back. I often go over general treatment options briefly and set up a follow up for usually within the week. I have had no problems with this approach or complaints from patients.

  10. Before scheduling a biopsy I have already had a discussion with the patient about why we are doing it. Often the patient wants to know then what his options are if the biopsy shows cancer and we will talk about that in general terms. At that time and again at the time of the biopsy I explain that the report will take two to three days to come back and that he will be called with the results. The patient doesn’t know this, but my nurses get the happy task of calling those with good news and I get the others. Over the phone I explain the results and what I think the range of treatments could be. I emphasize several times that this is a slow growing cancer and he will have plenty of time to acquire information, get second opinions, etc., so that he will feel comfortable with the decision that is right for him. I suggest that he and his wife or significant other come in for an appointment to discuss matters in more detail. Sometimes while they are on hold I will have one of the staff pick up the line and schedule a “cancer talk”. That is a block of time 45-60 minutes in length, usually at the end of the day when I will have enough time undisturbed with the patient to go over everything and answer his questions. If I schedule an appointment to tell every biopsy patient his results I would either block a lot of time to tell someone that they have nothing to worry about if the biopsy is clear or not enough time to tell them all I need to if it shows cancer.

  11. John Crook says:

    My wife and I think that Dr. Koch is one of the best in the U.S. We elected to do the HIFU surgery and it was repeated the second time. I still have cancer, but the treatment was the right choice for me. I still have the same options as before and the cancer is not aggressive. I would not hesitate to make the same decision again.

  12. A Workingman says:

    I knew when I got the call from the Doctor’s office asking me to come in. There are undoubtably exceptions to every rule, but I agree by the time it gets to the biopsy stage the surprise is pretty much shot.
    I liked the fact that my doctor made time for us the next day. It gave me a little time to think and write down some questions but not too much.
    I do not give my name because I am still in the working world and I don’t need my next employer taking a pass because I have Pca. I already lost my dream job when a friend let his mouth run. My wife had explained too much to his wife and sometimes it is an incredibly small world.

  13. Hi Dr. Savatta,
    As per your request, I have inquired with some French physicians, and this is what I came up with : generally speaking, they are reluctant to breaking the Pc news over the phone, as the generalisation of the cancer diagnosis disclosure procedure is currently being implemented in France. Please take a look at the following Blog post:
    http://robotchirurgie.blogspot.com/2006/04/france-le-dispositif-dannonce-du.html
    I’m awfully late to answer this request of yours, by the way. Sorry for that, hope the info will still be of some help. Best regards,
    CC

  14. jim_hayes says:

    I go for my second biopsy today the second one in 8 months my psa has gone from 5.3 to 28 in those few months. No I will not be surprised if I am told I have PC. I want to be told immediately the results, and over the phone is fine. I am 56 and would want to start arrangements for PC Treatment immediately.

  15. Janet says:

    Great! If only someone is willing to listen to these suggestions

  16. MJS says:

    I’m 41 years old and went in for a routine physical in August 2006. My PSA test came back at 2.5 which is a bit high for my age. I was referred to a urologist and he recommended that a biopsy be performed. Unfortunately, the results came back positive for cancer in October 2006. My gleason score was 6. I was pretty shocked at my age needless to say. After much research I opted for laproscopic surgery. It’s now January 2007 and been 8 weeks since the surgery. The cancer was contained to the prostate and had not spread into the lymph nodes. I’m doing fine and a recent PSA test came back at 0.1 which is great. My advice is to make sure that if you’re over 40 you insist on a PSA test. I got lucky that my general physician ran the PSA test. Typically they don’t run it unti 50 unless you have a family history of prostate cancer which I did not. I thank God and feel very grateful.

  17. robin Berens says:

    I was diagnosed with cancer in 1997, opted w/waiting. 2 years on Ornish study. NO intervention! PSA 40 Means little/bph per Stamey. Considering ext beam radiation, just found laproscopic, any comments please. rberens@sbcglobal.net

  18. This last entry was fairly unclear on specifics. A few points I can make are that watchful waiting can be a dangerous thing and should be done under the close supervision of a urologist.
    I am not familiar with the Ornish study, more info or a link would be appreciated.
    A PSA of 40 is very concerning for someone who has prostate cancer. Stamey has one opinion, and I, like many urologists do not agree with his thoughts on PSA. Stamey’s view are only for screening: He thinks a screening PSA tell you more about BPH than cancer. Once you have cancer he agrees with most urologists that PSAs are indicative of increasing tumor volume.
    I would seek out a good surgeon (lap,robot,or open) and a good radiation doc to go over my options at this point.
    Good luck

  19. charles b says:

    WHAT I WANT TO KNOW IS WHAT KIND OF FOLLOW UP SHOULD BE DONE AFTER PROSTATE CANCER SUGERY.I HAD ROBOTIC SUGERY IN DEC BUT I HAVEN’T FELT COMFORTABLE WITH MY LACK OF FOLLOW UP THAT I FEEL SHOULD HAVE BEEN DONE.

  20. I have my basic followup listed at my personal medical website, with the first year schedule being as such:
    I follow my patients for the first year in the following fashion:
    1 month- Prostate specific quality of life + PSA
    3 months- Prostate specific quality of life + PSA + AUASS + SHIM (if they are having erections
    6 months- Prostate specific quality of life + PSA
    9 months- Prostate specific quality of life + PSA
    12 months- Prostate specific quality of life + PSA + AUASS + SHIM (if they are having erections)
    This is not the only way to do it, but something I found useful.
    The main concerns are cancer control and making sure the patient is progressing towards sexual and urinary function recovery.
    Other visits are sometimes for issues after the catheter comes out (excessive burning, blood in the urine, pain).
    I have added biofeedbacks, starting after 1 month, for patients that are behind schedule on return of urinary function.
    I usually offer injection therapy for ed after 1-3 month for patients that want that.

  21. Marilyn Ellis says:

    Every patient wants to know results as quickly as possible. Waiting can be more agonising than knowing the truth about bad results. Patients and wives expect the worst anyway, and the longer the wait, the worse news they expect! Why wouldn’t you tell the patient immediately if the news was good?

  22. Clark Minton says:

    Every one should be mature enough to handle the news whether over the phone or in the office. If not, too bad for their lack of maturity. Time should be spent by the physician to map out all of the options for the patient. Candidily inform him that whatever road he takes if it is aggressive and out in the body there are very limited solutions all with quality of life problems. Each patient needs a lot more time with the PA , nurses and then the MD for these explanations.

  23. Bob Pinney says:

    I am scheduled for biopsy in 14days. I am obviously researching by responding to this post. I have to believe that most men do this research. I would strongly prefer the quickest result and time to get myself together for questions. Phone please