The association between race and treatment regret among men with recurrent prostate cancer

Abstract

BACKGROUND To examine the impact of race on treatment regret among men with recurrent prostate cancer after surgery or radiation. METHODS The prospective Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry was used to study a cohort of 484 men with biochemically recurrent prostate cancer after radical prostatectomy, external beam radiation or brachytherapy. Multivariable logistic regression was used to model the association between race and treatment regret and to determine whether there was an interaction between race and sexual problems after treatment with regards to treatment regret. RESULTS Black men (N = 78) were significantly more likely to have treatment regret when compared with non-black men (N = 406; 21.8% versus 12.6%) on univariable analysis (odds ratio (OR) 1.94; 95% confidence interval 1.05–3.56; P = 0.03). On multivariable analysis, black race trended towards but was no longer significantly associated with an increase in treatment regret (adjusted OR (AOR) 1.84 (0.95–3.58); P = 0.071). There was an interaction between race and sexual problems after treatment (Pinteraction = 0.02) such that among those without sexual problems, black men had more treatment regret than non-black men (26.7% versus 8.4%: AOR 4.68 (1.73–12.63); P = 0.002), whereas among those with sexual problems, there was no difference in treatment regret between black and non-black men (18.8% versus 17.3%: AOR 1.04 (0.44–2.46); P = 0.93). CONCLUSIONS Among men with recurrent prostate cancer after surgery or radiation, black men were nearly twice as likely to experience treatment regret. Treating physicians should ensure that patients are fully apprised of the pros and cons of all treatment options to reduce the risk of subsequent regret.

Longitudinal regret after treatment for low‐ and intermediate‐risk prostate cancer

“…In this study, African Americans had a 1.67 times greater odds of reporting regret than whites and other racial/ethnic groups, after adjustment for age, NCCN risk stratum, comorbidity, educational attainment, and control preference. This finding is consistent with previous studies that observed an almost 2‐fold difference in decisional regret between African Americans and whites who underwent robotic‐assisted laparoscopic prostatectomy or had biochemically recurrent prostate cancer . A third study found no difference in decisional regret across race for prostate cancer patients younger than 65, but greater regret among whites compared with African Americans in patients ≥65 years of age .…”

“…This finding is consistent with previous studies that observed an almost 2-fold difference in decisional regret between African Americans and whites who underwent robotic-assisted laparoscopic prostatectomy 8 or had biochemically recurrent prostate cancer. 27 A third study found no difference in decisional regret across race for prostate cancer patients younger than 65, but greater regret among whites compared with African Americans in patients 65 years of age. 3 The current study also tested for an interaction between age and race, but no interaction was observed.…”

Prostate brachytherapy in Ghana: our initial experience

“…Therefore, additional outcome measures and patient preferences should be evaluated prior to treatment selection. Toxicity and quality of life have become important endpoints considered by most patients in the process of selecting a treatment modality [25, 26, 27]. Recent reports show that among the primary treatments for prostate cancer (brachytherapy, radical prostatectomy, and external beam radiation therapy – EBRT), brachytherapy has the least effect on over-all quality of life [28].…”

Understanding Advanced Prostate Cancer Decision Making Utilizing an Interactive Decision Aid

“…There are numerous difficult decisions that patients with advanced prostate cancer must make, including treatment options, cost of care, and family involvement; however, over time patients with advanced cancer often regret some past decisions 6–8 . Many factors may increase the likelihood that patients will not have complete information at the time it is needed in order to optimize decision making, for example time constraints, forgetting to ask questions, and provider-patient miscommunication 9–12 .…”