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Long-term decision regret after post-prostatectomy image-guided intensity-modulated radiotherapy
Thomas P Shakespeare1,2, Stephen Chin1, Lucy Manuel2
1Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.
Journal of Medical Imaging and Radiation Oncology
|August 18, 2016
Summary
Decision regret is uncommon after prostate cancer surgery and radiotherapy. Patients expressed more regret about radical prostatectomy than post-operative radiotherapy, highlighting the need for informed treatment choices.
Area of Science:
- Urology
- Radiation Oncology
- Medical Decision Making
Background:
- Decision regret (DR) can arise when patients feel a different management choice would yield a better outcome.
- While DR after localized prostate cancer treatment is studied, it remains unexplored in patients receiving both surgery and post-prostatectomy radiotherapy.
Purpose of the Study:
- To evaluate decision regret in patients treated with radical prostatectomy (RP) followed by image-guided intensity-modulated radiotherapy (IG-IMRT).
- To assess DR for specific components of treatment, including RP, IG-IMRT, and androgen deprivation therapy (ADT).
Main Methods:
- A survey of 83 patients with a minimum 5-year follow-up after RP and IG-IMRT.
- Utilized a validated questionnaire to identify DR based on patient indications of wishing for alternative treatment or a desire to change their decision.
Main Results:
- Overall, 16.9% of patients reported DR. Regret was significantly higher for RP compared to radiotherapy (16.9% vs 4.2%, P=0.01).
- DR was associated with surgery toxicity, inadequate information about radiotherapy alternatives, positive surgical margins, and costs.
- Patients undergoing salvage treatment reported higher overall and surgical regret compared to adjuvant approaches.
Conclusions:
- Decision regret is uncommon following RP and post-prostatectomy IG-IMRT.
- Patients experience more regret concerning RP than post-operative IG-IMRT, suggesting reassurance for urologists referring patients for radiotherapy.
- Emphasizes the importance of patient selection for RP, achieving clear surgical margins, and thoroughly discussing definitive radiotherapy as a surgical alternative.
