The Four Ps and Your Prostate

The Four Ps and your ProstateWe’ve been thinking a lot in recent months about age and its impact on mens’ experience with prostate cancer. This is a continual and growing theme that we’re trying to understand, and one question keeps popping up —- why should all men aged 70 and over be treated the same, when there is such wide variability in their overall physical health, mental health and lifestyle?

Men who come to the Focal Therapy Clinic are, by default, seeking a second opinion on treatments that have been recommended for them, and while they range in age they all share a desire to continue an active lifestyle both physically and mentally while they’re being treated for prostate cancer, and after treatment is completed. They come to us having a very different experience elsewhere. And they like to tell us about their experiences, so we are learning from them all the time.  And what we are learning deeply is that there are lots of men 70+ who are expecting a full 20+ years ahead of them, and don’t want to be comdemned to “elderly” status.

Fortunately, and conveniently, the concept of and narrative around age is changing, and fast. We’ve looked at chronological age and biological age in previous blogs and increasingly this distinction is gaining more acceptance both in concept and measurement.

A key challenge to integrating the changing narrative of ageing into patient advocacy and patient care is language; many, if not most people lack a vocabulary around ageing, which in turn limits them in engaging with and questioning medical professionals effectively. So for example, a conversation between a 75 year old man and his doctor around treatment options for prostate cancer may centre on his chronological age and treatments that are statistically well tolerated in men of that age. But if the same man had an evidence-based measure of his biological age, the conversation might change to include a focus on his activity levels and lifestyle, and a different range of treatments offered. Similarly a shift in language from “lifespan” to “healthspan”, where the former focuses on life measured in time and the latter on life measured as time in good health, would also change the conversation around survivorship.

We recently spoke about this with Dr Michael Sagner, current president of the European Society of Preventive Medicine and author of Lifestyle Medicine, who advocates for a “healthspan” approach to medical care based upon “4 Ps”

  • Prediction – will my care predict the onset or recurrence of disease?
  • Prevention – will my care help me to prevent disease?
  • Personalisation – is my care personalised to me and/or targeted to my experience with disease?
  • Participation – do I have an active role in deciding procedures and treatments?

Along with a team of researchers, he has developed an integrative approach to chronic disease, including cancer:

“with slowly progressing and often ‘silent’ chronic diseases now being the main cause of illness, healthcare and medicine must evolve into a proactive system, moving away from a merely reactive approach to care. Minimal interactions among the specialists and limited information to the general practitioner and to the individual receiving care lead to a fragmented health approach, non-concerted prescriptions, a scattered follow-up and a suboptimal cost-effectiveness ratio.” 

He believes this is best addressed through a new approach that is

“predictive, preventive, personalized and participatory, which we label here as “P4” , holds great promise to reduce the burden of chronic diseases by harnessing technology and an increasingly better understanding of environment-biology interactions, evidence-based interventions and the underlying mechanisms of chronic diseases.” 

Why does this matter to men with prostate cancer?

  1. After diagnosis and treatment you’re different – physically and mentally, hopefully for a temporary period, but an approach to care that is driven by 4 Ps gives structure and focus to getting well and staying healthy
  2. It gives a language and structure to conversations with medical professionals that can overcome ageism or other biases, allowing you to focus on 4 simple objective elements to your care
  3. Looking at your medical care through this framework will make you think more carefully about what you are being offered by doctors and possibly leading you to seek better care
  4. The 4P approach provides a useful backdrop to considering care alternatives and can help increase confidence in researching and interrogating diagnostic procedures and treatment options

Do you agree with this approach? Have you experienced any of its elements in your own medical care? Have you experienced ageism, or felt de-personalised in your medical treatment? We’d love to hear from you.

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