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Patient perceptions and prostate cancer treatment choices

Posted May 25 2010 12:00am


At urology clinics in three states in the USA, prostate cancer patients were asked, after diagnosis but before treatment, about their likes and dislikes of five common treatment options.. The five options were radical prostatectomy, brachytherapy, external beam radiation therapy, hormone therapy, and watchful waiting

The objective of this study by Zeliadt et al. was to assess factors that might be affecting the men’s preference for surgical as compared to non-surgical options for treatment for local-stage prostate cancer.

The patient completed a detailed survey, with the following results:

  • 198 eligible men returned the baseline survey.
  • 117/198 (59 percent) indicated they only considered surgery as an option
  • 81/198 (41 percent) considered at least one non-surgical option.
  • Patients who thought treatment efficacy was a primary concern were significantly more likely to prefer surgery only.
  • Patients with concerns about personal burdens were significantly more likely to prefer non-surgical options.
  • Advice of friends and relatives and concerns over side effects were not significantly associated with a preference for surgery versus other treatments.

It is clear from this study that patient’s perceptions about efficacy and the personal burden of treatment dominated their preferences for surgical as compared to non-surgical treatment options.

The authors further state that, “Interventions to aid treatment decision making should account for these elements to minimize the impact of physician biases and patient misperceptions on men’s decisions as how best to manage their prostate cancer.” The “New” Prostate Cancer InfoLink has not seen the actual survey questions used. However, we suspect that the use of the term “watchful waiting” is, in itself, part of the problem, and that the term “active surveillance” might have been a more appropriate choice of terminology.

There is little doubt that patients who see only a urologist have a high probability of selecting surtgery as a treatment option. The appropriateness of that decision, absent other relevant data, is harder to assess.


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