What influences men’s decision making for treatment of localised prostate cancer?

Review date: July 2019

Prostate cancer is the top diagnosed cancer in men over the age of 50 but has a very good survival rate. A diagnosis of prostate cancer can be a worrying and emotional experience, and making treatment choices can be daunting. It is important to understand how men make treatment decisions, what they understand about the treatments offered, and what their preferences are for receiving information, so that doctors can best support men in making informed treatment decisions.

Treatment options for localised prostate cancer include active surveillance (monitoring of low-risk cancer), surgery to remove the prostate (open or robotic prostatectomy), or radiotherapy. Studies show that these treatments all give the same likelihood of survival. However, surgery and radiotherapy can come with specific side effects that may influence decisions when choosing a treatment.

The Prostatectomy versus Radiotherapy for Early-stage Prostate Cancer (PREPaRE) study1, set at the Liverpool Hospital in Sydney, NSW, aimed to understand how men choose treatments for prostate cancer. After receiving a diagnosis of prostate cancer, men enrolled in the study attended a ‘combined clinic’ where they received information about surgery or radiotherapy treatment options from doctors specialising in those areas (a urologist and a radiation oncologist). The study recruited 25 men with localised prostate cancer who completed surveys and took part in interviews to share their experiences on how they reached treatment decisions.

The main findings and recommendations of the study were:

• Patients have great trust in their doctors. The specialist (e.g. urologist/radiation oncologist) strongly influences the treatment decision. Not all patients were aware of the option of radiotherapy before the combined clinic appointment. Given that doctors are likely to be biased toward their specialty, it is important that patients receive balanced information from both a urologist and a radiation oncologist early on, preferably at the stage of diagnosis.
•  Patients mistakenly thought that compared to radiotherapy, surgery offered an increased survival rate and reduced likelihood of the cancer returning. Patients made decisions based on how they perceived the treatment was related to survival, rather than what the consequences (side effects) of the different treatments were. More education and better communication is needed so that men are fully aware of all the facts about different treatments, including the side effects.
•  Patients stated differing preferences for receiving information about treatments for their prostate cancer. Some preferred receiving information booklets and other resources, while some only wanted to get information from their doctor. There was a general lack of information resources on radiotherapy for prostate cancer. A tailored approach is needed so that each patient is fully informed and supported before making treatment decisions.