Treatment Decisions for Localized Prostate Cancer

Asking Men What's Important


  • Eric S. Holmboe MD,

    1. Division of General Medicine, National Naval Medical Center, Bethesda, Md
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  • John Concato MD, MS, MPH

    1. Clinical Epidemiology Unit, West Haven Veterans Affairs Medical Center, West Haven, Conn
    2. Department of Medicine and the Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn
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  • Presented in part at the 1998 annual meeting of the Society for General Internal Medicine.

  • The opinions expressed herein are solely those of the authors and do not represent the views of the Department of Defense, the Department of the Navy, or the Department of Veterans Affairs.

Address correspondence to Dr. Holmboe: 17112 Cherry Valley Court, Rockville, MD. 20853 (e-mail: or


OBJECTIVE: To identify what factors men consider important when choosing treatment for prostate cancer, and to assess why men reject watchful waiting as a treatment option.

PARTICIPANTS:One hundred two consecutive men with newly diagnosed localized prostate cancer identified from hospital and community-based urology practice groups.

MEASUREMENTS: Patients were asked open-ended questions about likes and dislikes of all treatments considered, how they chose their treatment, and reasons for rejecting watchful waiting. The interviews were conducted in person, after the men had made a treatment decision but before they received the treatment.

MAIN RESULTS: The most common reasons for liking a treatment were removal of tumor for radical prostatectomy (RP) (n = 15), evidence for external beam radiation (EBRT) (n = 6), and short duration of therapy for brachytherapy (seeds) (n = 25). The most frequently cited dislikes were high risk of incontinence for RP (n = 46), long duration of therapy for EBRT (n = 29), and lack of evidence for seeds (n = 16). Only 12 men chose watchful waiting. Fear of future consequences, cited by 64% (n = 90) of men, was the most common reason to reject watchful waiting.

CONCLUSION: In discussing treatment options for localized prostate cancer, clinicians, including primary care providers, should recognize that patients' decisions are often based on specific beliefs regarding each therapy's intrinsic characteristics, supporting evidence, or pattern of complications. Even if patients do not recall a physician recommendation against watchful waiting, this option may not be chosen because of fear of future consequences.