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Treatment decisions for localized prostate cancer

Asking men what’s important

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Abstract

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.

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References

  1. Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1998. CA Cancer J Clin. 1995;48:6–29.

    Google Scholar 

  2. Woolf SH. Screening for prostate cancer with prostate-specific antigen. N Engl J Med. 1995;333:1401–5.

    Article  PubMed  CAS  Google Scholar 

  3. Dorr VJ, Williamson SK, Stephens RL. An evaluation of prostatespecific antigen as a screening test for prostate cancer. Arch Intern Med. 1993;153:2529–37.

    Article  PubMed  CAS  Google Scholar 

  4. Perkins T. Concern grows over prostate cancer treatment options. JNCI. 1994;86:987–8.

    Google Scholar 

  5. Menon M, Parulker BG, Baker S. Should we treat localized prostate cancer. An opinion. Urology. 1995;46:607–15.

    Article  PubMed  CAS  Google Scholar 

  6. Walsh PC. The natural history of localized prostate cancer: a guide to therapy. In: Walsh PC, Retik AB, Vaughn ED, Wen AJ, eds. Campbell’s Urology. Philadelphia, PA: W.B. Saunders; 1998:2539–44.

    Google Scholar 

  7. Hahn DL, Roberts RG. Screening for asymptomatic prostate cancer: truth in advertising. J Fam Pract. 1993;37:432–6.

    PubMed  CAS  Google Scholar 

  8. Litwin MS, Hays RD, Fink A., et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. 1995;273:129–35.

    Article  PubMed  CAS  Google Scholar 

  9. Andriole GL, Smith DS, Rao G, Goodnough L, Catalona WJ. Early complications of contemporary anatomical radical retropubic prostatectomy. Urology. 1994;152(5 Pt 2):1858–60.

    CAS  Google Scholar 

  10. Fowler FJ, Roman A, Barry MJ, Wasson J, Lu-Yao G, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy. The national Medicare experience: 1988–1990. Urology. 1993;42:622–9.

    Article  PubMed  Google Scholar 

  11. Garnick MB, Fair WR. Prostate cancer: emerging concepts. Part I. Ann Intern Med. 1996;125:118–25.

    PubMed  CAS  Google Scholar 

  12. Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wennberg JE. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA 1993;269:2650–8.

    Article  PubMed  CAS  Google Scholar 

  13. Schroder FH. Screening, early detection, and treatment of prostate cancer: a European view. Urology. 1995;46:62–70.

    Article  PubMed  CAS  Google Scholar 

  14. Graverson PH, Nielsen KT, Gasser TC, Corle DK, Madsen PO. Radical prostatectomy versus expectant primary treatment in stages I and II prostatic cancer. A fifteen year follow-up. Urology. 1990;36:493–8.

    Article  Google Scholar 

  15. Middleton RG, Thompson IM, Austenfeld MS, et al. Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association. J Urol. 1995;154:2144–8.

    Article  PubMed  CAS  Google Scholar 

  16. Saltus R. For prostate cancer there’s no magic bullet. Boston Globe. January 12, 1998:C1.

  17. Schapira MM, Nattinger AB, Katz DA, Lawrence W. Information seeking and satisfaction with treatment decision in patients with clinically localized prostate cancer. Med Decis Making. 1997;17(suppl):544. Abstract.

    Google Scholar 

  18. Fowler FJ, Bin L, Collins MM, et al. Prostate cancer screening and beliefs about treatment efficacy: a national survey of primary care physicians and urologists. Am J Med. 1998;104:526–32.

    Article  PubMed  Google Scholar 

  19. Feinstein AR. Clinimetrics. New Haven: Yale University Press; 1987.

    Google Scholar 

  20. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  21. D’Amico AV, Coleman CN. Role of interstitial radiotherapy in the management of clinically organ-confined prostate cancer: the jury is still out. J Clin Oncol. 1996;14:304–15.

    PubMed  CAS  Google Scholar 

  22. Slovic P. Perception of risk. Science. 1987;236:280–5.

    Article  PubMed  CAS  Google Scholar 

  23. Kattan MW, Cowen ME, Miles BJ. A decision analysis for treatment of clinically localized prostate cancer. J Gen Intern Med. 1997;12:299–305.

    Article  PubMed  CAS  Google Scholar 

  24. Johansson JE. Watchful waiting for early stage prostate cancer. Urology. 1994;43:138–42.

    Article  PubMed  CAS  Google Scholar 

  25. Sandhu SS, Kaisary AV. Localised carcinoma of the prostate: a paradigm of uncertainty. Postgrad Med J. 1996;73:691–6.

    Google Scholar 

  26. Chodak GW. The role of watchful waiting in the management of localized prostate cancer. J Urol. 1994;152:1766–8.

    PubMed  CAS  Google Scholar 

  27. Steinberg GD, Bales GT, Brendler CB. An analysis of watchful waiting for clinically localized prostate cancer. J Urol. 1998;159:1431–6.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. the Division of General Medicine, National Naval Medical Center, Bethesda, Md

    Eric S. Holmboe MD

  2. Clinical Epidemiology Unit, West Haven Veterans Affairs Medical Center, West Haven, Conn

    John Concato MD, MS, MPH

  3. Department of Medicine and the Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn

    John Concato MD, MS, MPH

Authors
  1. Eric S. Holmboe MD
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  2. John Concato MD, MS, MPH
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Corresponding author

Correspondence to Eric S. Holmboe MD.

Additional information

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.

Dr. Holmboe completed this work as a Fellow in the Robert Wood Johnson Clinical Scholars program, Yale University School of Medicine. Dr. Concato is supported by a Career Development Award from the VA Health Services Research and Development Service.

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Holmboe, E.S., Concato, J. Treatment decisions for localized prostate cancer. J GEN INTERN MED 15, 694–701 (2000). https://doi.org/10.1046/j.1525-1497.2000.90842.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2000.90842.x

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