OLDER PATIENTS WILLINGNESS TO TRADE-OFF UROLOGIC ADVERSE OUTCOMES FORA BETTER CHANCE AT 5-YEAR SURVIVAL IN THE CLINICAL SETTING OF PROSTATE-CANCER

OBJECTIVE: To assess whether patients report a willingness to trade-of f urologic adverse outcomes-urinary incontinence and total impotence-f or a better chance of 5-year survival in the clinical setting of prost ate cancer; and, if so, whether patients' current levels of symptoms o f urinary incontinence, impotence, and frequency of sexual activity in fluence their decisions. DESIGN: Structured interviews with a convenie nce sample of male patients. SETTING: A university-based Department of Veterans Affairs Medical Center. PATIENTS: One hundred sixty-three pa tients seen consecutively in General Medicine Clinic at the Department of Veterans Affairs Medical Center in Portland, Oregon, were enrolled in the study. Mean age of the patients was 65.2 years (SD = 10.6, ran ge = 35-84); mean level of formal education completed was 13 years (SD = 2.7, range = 5-19). MEASUREMENTS: In a hypothetical clinical settin g of prostate cancer, patients were offered a choice of two procedures -Treatment A (surgery: worse short-term, better long-term survival) an d Treatment B (radiation therapy: better short-term, worse long-term s urvival)-with varying benefit/risk trade-offs in time. Patients were p resented with pairs of treatment curves that were developed from resea rch data on survival for surgery versus radiation therapy for stage II prostate cancer confined to the prostate gland. Treatments were not i dentified to control for labeling effects. Patients were asked their w illingness to accept a chance of immediate mortality for better 5-year survival in one of four treatment curve comparisons. Of those who acc epted the net beneficial procedure, we then inquired as to whether uro logic complications-urinary incontinence and wearing an appliance to c ollect urine or total impotence-altered the acceptability of that trea tment. RESULTS: Ninety-four percent (153/163) of patients were willing to choose Treatment A (worse short-term, better long-term survival) o n one of the four scenarios; the remainder (10/163) were unwilling to take Treatment A (worse short-term, better long-term survival) on any of the four scenarios. Sixty-two percent (95/153) of patients were wil ling to accept a 100% chance of urinary incontinence; 83% (127/153) we re willing to accept a 100% chance of impotence (chi-square = 16.8 wit h 1 df, P = .0001). CONCLUSIONS: Our results in an older male veteran population suggest than many patients are more concerned with long-ter m survival in the clinical setting of prostate cancer than with short- term treatment risks. In addition, patients are more willing to accept an impotence outcome than a urinary incontinence outcome, but this re sult was not related to patients' reported frequency of sexual activit y.