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Treatment decision-making in localized prostate cancer: why patients chose either radical prostatectomy or external
Andreas Ihrig1, Monika Keller, Mechthild Hartmann
1Division of Psycho-Oncology, University of Heidelberg, Germany. aihrig@med.uni-heidelberg.de
Objectives:
• To evaluate patients' treatment decision-making for localized prostate cancer. • To determine their willingness to participate in a randomized controlled trial (RCT) comparing radical prostatectomy (RP) with external beam radiation therapy (EBRT).
Patients And Methods:
• We investigated 31 patients with localized prostate cancer who had opted for either RP (n= 18) or EBRT (n= 13) as primary therapy. • A semi-structured interview and a short questionnaire were completed a few days after the start of treatment, covering all aspects of treatment decision.
Results:
• Most patients wanted to decide on their treatment together with their physician and were generally satisfied with the information provided. Internet resources were used more frequently by the RP group (14/18 patients) than by the EBRT group (three of 13 patients, P < 0.01). • Physicians' advice and other patients' experiences were highly influential in the final treatment decisions. • Patients deciding on RP were younger and their personal beliefs were their typical decision criteria (RP, six of 18 patients vs EBRT, none; P= 0.03). By contrast, possible treatment-related side-effects were a major concern for patients choosing EBRT (RP, two of 18, vs EBRT, seven of 14; P= 0.02). • Only two patients (of 31, 6%) would have consented to random assignment to either RP or EBRT, while six (19%) patients were not averse.
Conclusions:
• Patients are satisfied with the information provided and with their decision-making process. • Typical modes of reasoning can be found and mainly consist of personal beliefs in patients choosing RP and fear of treatment related side-effects in those choosing EBRT. • According to the sample, the participation rate for a RCT comparing RP to EBRT would not exceed 25% without further efforts.
