Top Line: Do men with localized prostate cancer regret their management decisions?
The Study: The ProtecT trial showed no major differences in mortality outcomes between surgery, radiation, and active monitoring for localized prostate cancer. But it did show a slightly higher rate of metastasis with monitoring, higher rates of incontinence and impotence with surgery, and higher rates of bloody stool with radiation. This prospective, population-based study evaluated decision regret among > 2000 men who underwent active surveillance, surgery, or radiation for localized prostate cancer. At 5 years, 7% of men on active surveillance, 11% who had radiation, and 17% who had surgery had decision regret. Comparing modalities, men who had surgery had significantly higher regret than those who had AS. Importantly, what patients seemed to regret most were certain effects of treatment. When functional outcomes were factored, it was actually patient-reported sexual dysfunction (and not modality) that was significantly associated with regret. The problem is that sexual dysfunction is greater after surgery than radiation or AS. The two things most strongly associated with regret, though, were when patients perceived that their treatment efficacy or toxicity was a lot worse (compared to better/same/little worse) than their pre-treatment expectation. Improved pretreatment communication of mortality risk, treatment outcomes, and realistic toxicity expectations would go a long way in reducing treatment regret.
TBL: Men with localized prostate cancer whose treatment outcome and/or toxicity is worse than their initial expectation and men who experience sexual toxicity are more likely to regret their treatment decision. Among treatment modalities, men who have surgery (but not radiation) have more regret than those who have AS. | Wallis, JAMA Oncol 2021