15 percent of men regret prostate cancer treatment choices years later, study finds

After years of introspection, about 15 percent of men with localized prostate cancer regretted the decisions they made regarding treatment, a survey of almost 1,000 patients showed.

About twice as many men expressed regret after radical prostatectomy or radiation therapy as compared with active surveillance. The single biggest contributor to regret was treatment-associated sexual dysfunction, as reported in the Journal of Clinical Oncology.

“Regret was a relatively infrequently reported outcome among long-term survivors of localized prostate cancer,” Dr. Richard M. Hoffman of the University of Iowa in Iowa City and co-authors concluded. “However, our results suggest that better informing men about treatment options, in particular, conservative treatment, might help mitigate long-term regret. These findings are timely for men with low-risk cancers who are being encouraged to consider active surveillance.”

“These findings are particularly relevant now when men with low-risk cancers are facing challenging decisions between selecting an active treatment or active surveillance that presents a potential trade-off between cancer control and adverse effects,” they added.

The findings leave little doubt about the importance of informed decision making and the need for physician-patient discussions prior to deciding a course of action for early-stage prostate cancer, said Dr. Otis Brawley, chief medical officer for the American Cancer Society in Atlanta.

“I think that this whole paper is a huge cry that we need to make sure that people are informed and are taking part in their treatment decisions,” Brawley told MedPage Today.

The lower rate of regret among men on active surveillance might also reflect on the informed decision-making process, although the study did not specifically examine that issue, he added.

“In the United States, it’s almost impossible to put someone on observation, after you have told them they have cancer, and not inform them, the way I think someone should be informed,” said Brawley. “It’s very easy to tell someone you have cancer and we’re going to do a radical prostatectomy next Monday and not inform them. It may very well be that the people who got observation were more fully or better informed and better understood what they were facing, compared with the people who got aggressive therapy.”

The study had its genesis in the recognition that many early-stage prostate cancers have an indolent clinical course and are unlikely to evolve into life-threatening disease. The recognition sparked controversy and discussion about tradeoffs between treatment options and treatment-associated adverse effects. Increasingly, recent clinical guidelines have emphasized the need for informed discussions between patients and clinicians before deciding how to manage early prostate cancer.

A study reported earlier this year reinforced the need for informed decision making based on physician-patient discussions about treatment options. The study showed high rates of regret among men who relied primarily on internet-based information about prostate cancer treatment to decide how their own disease should be treated.

Hoffman and co-authors surveyed 934 patients with early-stage prostate cancer enrolled in one of six U.S. cancer registries from 1994 to 1995 and who had at least 15 years of follow-up. The survey instrument elicited information about general health status and clinical and demographic factors, as well as treatment decisions, informed decision making, regret, and outlook on life.

Almost 60 percent of the patients had low-risk disease characteristics (PSA <10 ng/mL and Gleason score <7), and 89 percent underwent active treatment at some point during follow-up.

Overall, 14.6 percent of the survey participants expressed regret about their treatment decisions. The total regret percentage included 8.2 percent of men who opted for conservative management (including active surveillance), 15.0 percent of men who had surgery, and 16.6 percent of those who underwent definitive radiotherapy.

The authors performed a multivariable analysis to identify factors associated with treatment regret. They found that moderate or substantial sexual dysfunction was the most commonly cited factor associated with decision regret, mentioned by 39 percent of men with regret. The only other significant factors were moderate or substantial bowel function bother, and concerns about rising PSA levels.

Older age at cancer diagnosis and informed treatment decision making had inverse associations with regret, the authors reported.

This story was originally published by MedPage Today. Hoffman disclosed no relevant relationships with industry. One or more co-authors disclosed relationships with Blue Cros & Blue Shield, Astellas, Dendreon, Medivation, and royalty/patent interests.