A new study examines treatment-related regrets among prostate cancer patients.
Men newly diagnosed with prostate cancer have difficult treatment decisions, and the last thing any of them wants is to subsequently regret their treatment choices. Regrets about therapy, however, are extremely common, according to a new study.
The research discovered that more than one in ten individuals diagnosed with prostate cancer between 2011 and 2012 were dissatisfied with their selected treatment.
All of the guys were under the age of 80, with an average age of 64. Almost half of them were diagnosed with slow-growing malignancies that had a low chance of recurrence or spread following treatment. The remainder were classified as being at intermediate or higher risk.
All of the men were treated in one of three ways: surgical removal of the prostate (called a radical prostatectomy); radiation therapy; or active surveillance, which involves monitoring prostate tumors with routine PSA tests and imaging and treating only when, or if, the disease progresses. Regardless of their cancer risk at the time of diagnosis, more than half of men opted for surgery. The majority of others chose radiation, while almost 13% of males — the bulk of whom were classified as low- or intermediate-risk — chose active surveillance. The guys were then asked at repeated intervals if they felt they would have been better off with a different strategy or if the treatment they had selected was wrong.
What the findings revealed
After five years, 279 of the males (or 13% of the overall group) expressed regret about their choice. Men who had surgery were the most likely to express dissatisfaction with their decision; 183 of them (13%) felt they would have been better off taking a different method. In comparison, 76 (11%) of radiation-treated men and 20 (7%) of men who selected active surveillance voiced remorse. Men in the low-to-intermediate-risk category expressed greater regret about electing for immediate treatment with surgery or radiation over active surveillance. However, the guys with high-risk cancer did not regret receiving immediate treatment.
Dr. Christopher Wallis, a urologic oncologist at Mount Sinai Hospital in Toronto, Canada, led the study. Wallis and his colleagues did not investigate which specific disease outcomes or complications contributed to patients' regrets about particular treatments. However, the study discovered a substantial association between sexual dysfunction and treatment regrets in general. "And patients on active monitoring may experience regret if their condition develops and they believe they would have been better off receiving treatment sooner," Wallis noted in an email.
According to the researchers, the study's central finding is that regrets occur as a result of mismatches between what men expect from a certain method and their actual experiences over time. "That is a critical takeaway," Wallis stated.
Randy Jones, PhD., RN, a professor at the University of Virginia School of Nursing, underlined in an accompanying editorial that improved treatment counseling at the time of diagnosis can help lessen the likelihood of subsequent regret. He said that this communication should take into account the patient's own values, emphasize collaborative decision-making between patients and clinicians, and strive for an "understanding of realistic expectations and possible adverse consequences throughout treatment."
Marc Garnick, MD, is the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. He is the editor of the Harvard Health Publishing Annual Report on Prostate Diseases HarvardProstateKnowledge.org, said, "This study emphasizes the need of not rushing into a decision and thoroughly understanding the time course of side effects and what may be expected from them." "Only when the patient has a complete understanding of the repercussions of treatment(s) or surveillance is the patient able to make an educated decision." All too frequently, newly diagnosed individuals respond by "desiring to address this as quickly as possible." However, people with prostate cancer have the opportunity to fully comprehend what is at risk. "Having a conversation with other prostate cancer patients and members of support organizations is a great way to get a sense of what to expect in the long run. The fact that this study analyzed individuals 10+ years after their decision is critical in assisting us in better understanding the time course of regret.
