Early prostate cancer – which treatment do men prefer and why?

Abstract

Study Type – Preference (prospective cohort) Level of Evidence 1b What’s known on the subject? and What does the study add? In general the literature suggests that there is a need for improvement in aiding men diagnosed with early prostate cancer in their decision making about treatment options and that our understanding of this process is inadequate. There is limited data analyzing the reasons why these men decide between potentially curative or observational treatments and data evaluating patients’ views before and after definitive therapy are scarce. This study begins the process of understanding the reasons underlying a patient’s final treatment decision. Being a prospective study, it looks at the thought processes of these men before treatment during the time the decision is made. It also documents how satisfied patients are with their choice after their treatment and whether they would choose the same treatment again. OBJECTIVE • To identify the reasons for patients with localised prostate cancer choosing between treatments and the relationship of procedure type to patient satisfaction post‐treatment. PATIENTS AND METHODS • 768 men with prostate cancer (stage T1/2, Gleason ≤7, PSA <20 ug/L) chose between four treatments: radical prostatectomy, brachytherapy, conformal radiotherapy and active surveillance. • Prior to choosing, patients were counselled by a urological surgeon, clinical (radiation) oncologist and uro‐oncology specialist nurse. • Pre‐treatment reasons for choice were recorded. Post‐treatment satisfaction was examined via postal questionnaire. RESULTS • Of the 768 patients, 305 (40%) chose surgery, 237 (31%) conformal beam radiotherapy, 165 (21%) brachytherapy and 61 (8%) active surveillance. • Sixty percent of men who opted for radical prostatectomy were motivated by the need for physical removal of the cancer. • Conformal radiotherapy was mainly chosen by patients who feared other treatments (n = 63, 27%). Most men chose brachytherapy because it was more convenient for their lifestyle (n = 64, 39%). • Active surveillance was chosen by patients for more varied reasons. Post‐treatment satisfaction was assessed in a subgroup who took part in the QOL aspect of this study. • Of the respondents to the questionnaire, 212(87.6%) stated that they were satisfied/extremely satisfied with their choice and 171(92.9%) indicated they would choose the same treatment again. CONCLUSION • Men with early prostate cancer have clear reasons for making decisions about treatment. Overall, patients were satisfied with the treatment and indicated that despite different reasons for choosing treatment, they would make the same choice again.

Oncologic outcomes following radical prostatectomy in the active surveillance era

“…The growth of the intermediate-risk cohort may also have occurred as a result of patient preference for surgery over radiotherapy, which was previously preferred. 17 In addition, the later treatment group was significantly younger, which may influence treatment preference. 18,19 We considered alternate explanations for the shift in the risk profile of men presenting for RP independent of treatment decision and referral pattern, and while they cannot be precluded we consider them less likely.…”

Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation

“…4 (3) Age (years) Mean (SD, range) 68 (7.8, 46-83) PSA level (ng/ml) Mean (range) 155 (15) 4.1-10.0 ng/ml 301 (72) 661 (64) > 10 ng/ml 18 (4) 218 (21) Missing 0 5 Clinical stage, n (%) T1a-c 273 (65) 689 (67) T2a-c 144 (35) 321 (31) T3-T4 544 (53) 7 42 (10) 377 (36) 8-10…”

Clinical results of active surveillance for localized prostate cancer patients

“…Bu çalışmada cerrahiyi seçen hastaların %60'ı fiziksel olarak kanserden kurtulmayı amaçladığını belirtmiştir. [17,18] Bizim çalışmamızda kliniğimizde 2006-2012 yılları arasında lokalize prostat kanseri tanısı konan 196 hastadan 41'i (%20.9) kendisine sunulan tedavi seçeneklerinden aktif izlemi seçmiştir. Artan PSA taramaları ve biyopsi tekniğinde gelişmeler neticesinde son yıllarda düşük riskli prostat kanseri tanısında önemli oranlarda artış olmuştur.…”

“…Ortalama kor sayısı 13.59 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21) idi. İkinci biyopsi sonrasında 11 hastada tümör saptanmadı.…”