"The groundwork of all happiness is health." - Leigh Hunt

New study investigates treatment-related regret in prostate cancer

Men who're newly diagnosed with prostate cancer have a difficult time making decisions about medical treatment, and the final thing any of them want is to regret their treatment decisions later. But unfortunately, treatment-related regrets are all too common, based on A new study.

After taking a look at the experiences of two,072 men diagnosed with prostate cancer between 2011 and 2012, investigators found that a couple of in 10 were unhappy with the treatment they selected.

The men were all under 80 years of age, with a mean age of 64 years. About half of them had slow-growing cancers with a low risk of reoccurrence or spread after treatment. The rest were within the medium or high risk category.

All men were treated in one in every of three other ways: surgery to remove the prostate (a procedure called radical prostatectomy); radiation therapy; or energetic surveillance, which involves monitoring prostate tumors with routine PSA checks and imaging, and treating only when, or if, the cancer grows. More than half of the boys selected surgery no matter their cancer risk at diagnosis. Most of the others selected radiation, and about 13% of men – most of them within the low- or intermediate-risk categories – selected energetic surveillance. Then, at intervals thereafter, the boys filled out questionnaires asking in the event that they thought they may have been higher off with a distinct approach, or if the treatment that they had chosen was mistaken.

The results that got here out

The results showed that after five years, 279 of the boys (13% of all the group) regretted their selection. Men treated surgically were more more likely to express unhappiness with their decision. Of these, 183 (13%) felt they might have been higher off with a distinct approach. In contrast, 76 (11%) of men who received radiation treatment and 20 (7%) of men who selected energetic surveillance expressed regret. Men within the low- to moderate-risk categories were more more likely to regret selecting immediate treatment with surgery or radiation moderately than energetic surveillance. However, men at high risk of cancer didn't regret being treated immediately.

The research was led by Dr. Christopher Wallace, a urologic oncologist at Mount Sinai Hospital in Toronto, Canada. Wallis and his team didn't explore which specific disease outcomes or complications led to regret related to particular treatments. However, the study found that sexual dysfunction was significantly related to treatment regret usually. “And patients on active surveillance may have regrets if their disease progresses and they then begin to believe they could have gotten better with earlier treatment,” Wallis wrote in an email. I wrote

According to the researchers, the important thing finding of this study is that regrets arise from discrepancies between men's expectations of a selected perspective and their actual experiences over time. “That's the key takeaway,” Wallace said.

In one Accompanying editorial, Randy Jones, Ph.D., RN, professor on the University of Virginia School of Nursing, emphasized that higher treatment counseling on the time of diagnosis may help reduce the likelihood of later regret. He wrote that this communication should consider the patient's personal values, shared decision-making between patients and physicians, and aim for “realistic expectations and an understanding of possible adverse effects during treatment.”