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Keywords:

  • prostate cancer;
  • treatment;
  • demographic factors;
  • clinical factors;
  • decision-making

Study Type – Prognosis (cohort series)

Level of Evidence 2b

What's known on the subject? and What does the study add?

Men diagnosed with prostate cancer are increasingly involved in making their own treatment decisions and the current recommendations for treatment are based on informed choice. The absence of scientific evidence regarding optimum treatment choices underlines the importance of understanding which factors influence the selection of treatment by men diagnosed with prostate cancer. Previous studies have found that men diagnosed with prostate cancer were more likely to choose radiation therapy over radical prostatectomy if they were older and had a higher PSA level.

This is the first large-scale prospective study conducted outside the USA to quantify the factors associated with treatment decisions for men diagnosed with prostate cancer. It found that men who chose surgery were younger, above average physical health, and had lower grade cancers on the Gleason scale; men who had radiation therapy were older and had reduced physical health, with ADT added when men had more advanced disease. About two-thirds of the men said they primarily made the decision about treatment themselves, with the remaining men either sharing the decision-making process with their doctor or else leaving the decision more or less completely up to their doctor. These results highlight the importance of having quality up-to-date information readily available to guide these decisions.

OBJECTIVE

  • • 
    To examine demographic, clinical and quality-of-life indicators for the treatments received by men diagnosed with prostate cancer in Australia.

SUBJECTS AND METHODS

  • • 
    This prospective trial included men diagnosed with prostate cancer (n= 1064, response rate = 82%) between 2005 and 2007 in Queensland, Australia, sampled from urologists and hospital outpatient clinics.
  • • 
    Data were collected through telephone interviews and self-administered questionnaires.
  • • 
    Treatment received was categorized into five groups: radical prostatectomy; radiation therapy with neoadjuvant androgen deprivation therapy (ADT); radiation therapy alone; ADT alone; and monitoring.

RESULTS

  • • 
    Sharp contrasts in the choice between radical prostatectomy (47% of men) vs radiation therapy with ADT (30%) were evident among age at diagnosis, travel time to facilities offering radiation treatment, Gleason score, stage, body mass index and physical health.
  • • 
    Men who underwent surgery were younger and of above average physical health, and had lower grade cancers; men who underwent radiation therapy were older and less fit. ADT, in both neoadjuvant and definitive forms, was administered for high-risk and more advanced disease.
  • • 
    Two-thirds (66%) of men stated that they made the final treatment selection themselves.

CONCLUSIONS

  • • 
    These results suggest that men's baseline health and tumour characteristics influence treatment choices.
  • • 
    Distance from tertiary treatment centres also influenced the treatment received and access to specialist urologists may play a role.
  • • 
    With most men indicating high levels of decisional control, the importance of having quality up-to-date information readily available to guide their decisions cannot be overstated.