Review identifies factors that influence patient treatment choice for localized prostate cancer

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May 16 2006

Variables that influence a patients' choice of treatment for localized prostate cancer (CaP) are identified in a literature review that is authored by Dr. Zeliadt and colleagues and appears in the on-line version of Cancer, 2006.

Cancer eradication is a primary concern for many men, but perhaps surprisingly not paramount to all patients. One study of 1000 CaP patients found that 42% defined an effective treatment as one that extended survival or delayed disease progression, but 45% defined effectiveness as preservation of quality of life (QOL). This contrasted to physicians, of whom 90% defined effectiveness as extended survival. In another study, only 20% of CaP patients selected either "effect of treatment of length of life" or "chances of dying of cancer" as 1 of the 4 most relevant factors in making a decision.

It is apparent that CaP patients associate cancer eradication with aggressiveness of therapy and radical prostatectomy (RP) was considered the most aggressive. One study found that 98% of RP patients and 50% of brachytherapy patients selected their treatment choice on the basis of evidence that it was the most curative procedure.

Regarding QOL, the issue of incontinence was more concerning than impotence. In fact, urinary and bowel side effects were the only 2 variables found to be important to greater than 50% of patients. Another study found that 49% and 38% of patients were concerned about incontinence and impotence, respectively. However, this must be assessed in the context of their pre-operative functional status. One report found that 55% of spouses reported that side effects were important, but only 6% indicated that side effects were deciding factors.

Only 2% of men indicated that out-of-pocket costs were important in selecting treatment choice. While spouses often are very involved in obtaining treatment information, one study found that only 13% of patients thought they would base their decision on family influence.

Clearly, patients are more involved in the decision making process. The same survey given to 2 cohorts of patients 5 years apart finds that more recently 32% as compared to 58% wanted their physician to make the final decision. Also, patients most commonly rely on the opinion of their urologist. While 37% sought a second opinion, 75% selected the first treatment recommended to them.

Review of studies regarding racial, socioeconomic and cultural factors reveal that African-American men more commonly receive less aggressive therapy. However, more educated men more commonly had watchful waiting presented to them, while higher income patients had surgery or brachytherapy discussed.

Many variables are found to influence a patients' selection of treatment for localized CaP. In addition to cancer eradication and QOL, clearly the initial physician a CaP patient interacts with regarding their new diagnosis of CaP is the most influential.

By Christopher P. Evans, MD