Editing AUA: Clinically Localized Prostate Cancer (2017) (section)

===== Shared-decision making =====

* Counseling of patients to select a management strategy should incorporate shared decision making and explicitly consider cancer severity (risk category), patient values and preferences, life expectancy, pre-treatment general functional and genitourinary symptoms, expected post-treatment functional status, and potential for salvage treatment.
* Prostate cancer patients should be counseled regarding the importance of modifiable health-related behaviors or risk factors, such as smoking and obesity.
** Smoking and obesity are associated with increased risk of prostate cancer death
** Furthermore, smoking and obesity are associated with increased risk of perioperative complications
* Clinicians should encourage patients to meet with different prostate cancer care specialists (rad/onc, med/onc)
* Effective shared decision making in prostate cancer care requires clinicians to inform patients about immediate and long-term morbidity or side effects of proposed treatment or care options.

#* '''Surgery patients may experience bleeding, infection, and pain in the immediate term and then experience erectile dysfunction, urinary incontinence, urethral stricture and (very rarely) bowel problems.'''
#* '''The same side effects observed after surgery are possible with radiotherapy (RT) approaches, though bowel problems are more common, and sexual and continence side effects take much longer to develop.'''
#* '''Erectile dysfunction and urinary bother beyond 2-5 years may be similar between surgery and RT'''
#* '''RT causes more urinary irritation (brachytherapy more than external beam RT (EBRT)) and modestly more gastrointestinal side effects than radical prostatectomy'''
#* '''RT may be associated with a very small but increased risk for secondary cancer, specifically bladder cancer and rectal cancer. The suspected incidence of radiation-induced second primary cancers is reported to affect between 1-3% of patients in the years following treatment'''.
#* The risk of perioperative death from prostate cancer surgery is <0.1%