For men diagnosed with prostate cancer, deciding on a treatment path can be agonizing – and out of fear, many patients choose surgery or radiation therapy over the third choice of watchful waiting.

Two Eastern Virginia Medical School faculty members have developed an innovative method to help men, primary care physicians and specialists together make more educated choices. It includes a formula for a patient's health-adjusted life expectancy, simplified treatment guidelines, a patient questionnaire and a clear summary of treatment side effects.

"We wanted to come up with a clear road map to follow after diagnosis, which hasn't existed to this point," says Ravinder Mohan, MD, PhD, associate professor of family and community medicine and first author of "Treatment Options for Localized Prostate Cancer," published this month in the journal American Family Physician. Paul F. Schellhammer, MD, professor of urology, is a co-author.

Between 50 and 75 percent of prostate cancer patients don't need immediate treatment because they have a slow-growing form of cancer, Dr. Mohan says. Based on age, overall health and tumor stage and grade, they are more likely to die of a cause unrelated to that cancer. However, about 94 percent of all patients opt for an invasive procedure that can lead to incontinence, impotence and bowel problems.

Watchful waiting or active surveillance, on the other hand, involves regular monitoring with blood tests, digital rectal exams and biopsies, with the option to begin treatment at any time.

"The idea of not treating cancer is very hard for people to accept," Dr. Mohan says. "Decision choice is very hard and has been a problem for 20 years. Until now, review articles that physicians could use to advise patients only talked about pros and cons of surgery, radiation and observation, which left decision-making still difficult. Leaving patients to choose by their preferences without individualizing their decision-related factors made it even more difficult."

Drs. Mohan and Schellhammer's research has shown existing national treatment guidelines are difficult to follow and not used regularly. Their article also includes surveys of 184 local patients who, based on guidelines, as a majority chose overtreatment because they feared the cancer would quickly kill them.