Patient preferences and treatment choices for localized prostate cancer

After receiving cancer diagnosis, follows a chaotic time full of anxiety, fear and endless grief for the patients. Prostate cancer is the most common cancer amongst men in Canada and in the most cases it is diagnosed when it is still curable, nevertheless these men are faced with a long journey with many decision points along the road where they must manage their personal fear of a cancer death with the overwhelming thought of leaving their loved ones behind. In this state of mind, it is expected of the patients to get involved in the decision making process regarding their treatment.

Treatment options for localized prostate cancer are many, vary widely, and there is no consensus regarding the optimal treatment strategy. Ongoing research in the area of patients decision making and post intervention regret, reveals some insight in the patient’s choice of treatment option. Surgery is often preferred by patients seeking a cure, while brachytherapy is more often chosen by patients professing a desire for “the least invasive” treatment. Although patients stated that side effects are important, few patients report that side effect factors ultimately influence their treatment choice. However, there are several studies pointing out that men with prostate cancer often base treatment decisions on scientific misconceptions and anecdotal experiences of friends or family. Race/ethnicity and socioeconomic status plays a role as well.

Some studies show that the actual treatment choices bear little relation to the patient preferences, and instead show a strong association with clinician specialty. Physician’s advice depends heavily on the their specialty (radiation oncology vs. urology), as well as geographic region. In a recent study published in nature , researchers investigated the importance of physician’s attitudes about different treatments and the quality of life in prostate cancer, by performing a survey of specialists to assess treatment recommendations and perceptions of treatment related survival and quality of life. The conclusions from the study were that the radiation oncologists and urologists both prefer the treatment modalities they offer, perceive them to be more effective and to lead to a better quality of life. Patients receive biased information, and a truly informed consent process with shared decision making may be possible only if they are evaluated by both specialties before deciding upon a treatment course. In the absence of relevant randomized trials no decision regarding the superiority of any of the treatment modality can be made and the potential impacts of treatment side effects on quality of life for patients and their partners have to be considered in the informed decision making process.