Quality improvement report Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study Commentary: presenting unbiased information to patients can be difficult

Editor- Patients with localised prostate cancer and their clinicians
face a difficult choice of treatment options. The paper by Donovan et al
[1] is timely and addresses the management dilemma. It highlights the
importance of communication between the patient and his clinician in
deciding the treatment of the disease. Most of the trials comparing
various types of treatment for localised prostate cancer struggle to
recruit patients because of two extreme lines of management i.e. radical
surgery or radiotherapy and watchful waiting. Patients are often puzzled
by these options. This paper has demonstrated that it is possible to
convince patients to accept watchful waiting on their own accord by
careful presentation of information.

However it is still difficult to equate or compare watchful waiting
to radical treatment in prostate cancer. Management of patients with
localised disease depends on the age of the patient, histology and
associated medical conditions. High risk category localised prostate
cancer should be treated aggressively [2]. It is important for the
clinician to emphasize the factors which affect the prognosis to the
patient. Otherwise it may be unethical to advise these patients to go for
active monitoring.

1.Donovan J, Mills N, Smith M, Brindle L, et al. Improving design and
conduct of randomised trials by embedding them in qualitative research:
ProtecT (Prosatte testing for cancer and treatment) study. BMJ 2002; 325:
766-770.
2. Steinberg GD, Bales GT and Brendler CB. An analysis of watchful
waiting for clinically localised prostate cancer. J Urol 1998; 159: 1431-
1436.