Treatment decision‐making for localized prostate cancer: What younger men choose and why

Abstract

Background and Objective The literature lacks knowledge about information preferences and decision-making in young prostate cancer patients. This study provides insight into information sources consulted and factors dictating treatment decision-making in young prostate cancer patients. Methods Subjects were identified from pathology consult service of a National Center of Excellence. Questionnaires were mailed to 986 men, under 50 years of age, diagnosed with Gleason score 6 prostate cancer between 2001 and 2005. Results Four hundred ninety-three men responded. The most common primary therapies were surgery 397 (81.4%), radiation 52 (10.7%), and active surveillance (AS) 26 (5.3%). Participants with at least some college education (P = 0.003) or annual income >$100,000 (P = 0.003) were more likely to consult three or more doctors. Amongst all treatments, “doctor's recommendation” was the most influential information source, although relatively less important in the AS group. Internet was the second most frequent information source. Participants with higher education (P = 0.0003) and higher income (P = 0.002) considered sexual function more important while making a treatment choice. Only 2% of the men preferred a passive role in the decision-making. Informed decision-making was preferred more by patients who chose radiation and AS while shared decision-making was preferred more by surgery patients (P < 0.05). The majority (89%) of the respondents did not regret their decision. No difference in satisfaction levels was found between different treatment modalities. Conclusions This study provides insight into information sources consulted, such as the greater internet use, and various factors dictating treatment decision-making in young prostate cancer patients. There was an overall very high satisfaction rate regardless of the therapy chosen.

Oncologic outcomes following radical prostatectomy in the active surveillance era

“…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. Within the time period we examined, the Gleason scoring system changed resulting in tumours with primary pattern of Gleason 3 and less than 5% Gleason 4 to be classified as Gleason 7, whereas it was formerly classified as Gleason 6.…”

Acknowledging unreported problems with active surveillance for prostate cancer: a prospective single-centre observational study

“…Several studies report that fear of treatment-related side effects is a strong motivator for choosing AS. [22][23][24] At the same time it has been demonstrated that during FU anxiety is very low and therefore, seemingly not a problem in AS. 25 Surprisingly, the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) showed that men with an unsuspicious biopsy but suspicious PSA were significantly less likely to return for the scheduled FU compared with men with normal PSA.…”

“…Six men (10%) from the primarily TUR-P diagnosed and 26 (27%) from the TRUS diagnosed group (χ 2 p=0.009) progressed. Median time to reclassification for both groups (TUR-P and TRUS) was 24 (14-36) months and to treatment 26 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) months. For reclassification defined by volume, the criterion for receiving definitive treatment for more than two cancerous GS-5 biopsy cores were met in three patients, and GS-6 biopsy cores were found in eight patients.…”

Prostate cancer in young men: an important clinical entity

“…Studies on treatment decisions in younger patients also suggest that different priorities and concerns may exist compared to older men. For example, among men diagnosed with Gleason grade 6 prostate cancer, younger men placed a greater importance on sexual function after treatment than urinary function 93 . In an older group of prostate cancer patients with an average age of approximately 65 years, fear of incontinence was cited as a greater concern than impotence in their treatment decisions 94 .…”