December 9, 2021

Prostate cancer treatment regret

Vanderbilt researchers suggest that to reduce treatment-related regret for men with localized prostate cancer, treatment preparation should focus on shared decision-making and aligning patient expectations with treatment toxicity.

by Leigh MacMillan

More than one in 10 patients with localized prostate cancer experience treatment-related regret — a sense of disappointment with their treatment compared to other treatment options — according to a recent study published in JAMA Oncology. 

Christopher Wallis, MD, PhD, and colleagues analyzed data from 2,072 men with localized prostate cancer who participated in the prospective Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Patients completed surveys at baseline and multiple times after diagnosis. 

Using validated metrics, the researchers found that 16% of patients who had surgery, 11% of those who had radiotherapy, and 7% who had active surveillance experienced treatment-related regret five years after diagnosis. Most importantly, patients’ subjective perceptions of the treatment’s efficacy and adverse effects, compared to their initial expectations, were the strongest predictors of regret. 

The findings suggest that shared decision-making and treatment preparation that focuses on aligning patient expectations with treatment toxicity may reduce regret for patients with localized prostate cancer.

Wallis, now assistant professor of Urology at the University of Toronto, completed the study during his urology fellowship at VUMC. Other VUMC authors include Zhiguo Zhao, Li-Ching Huang, PhD, David Penson, MD, MPH, Tatsuki Koyama, PhD, Amy Luckenbaugh, MD, Ralph Conwill, and Daniel Barocas, MD, MPH. 

This research was supported by the Agency for Health Care Research and Quality (grants HS019356, HS022640), Patient-Centered Outcomes Research Institute, and National Institutes of Health (grant CA230352).