Primary treatment choices for men with clinically localized prostate carcinoma detected by screening

BACKGROUND. Increasingly, prostate carcinoma is diagnosed through screening . However, little is know regarding factors that influence a patient's deci sion concerning the treatment choices presented to him. METHODS. Subjects were prostate carcinoma patients detected through the Was hington University PSA Prostate Cancer Screening Program between September 1989 and June 1998. The sources of data were the prostate specific antigen (PSA) screening database and follow-up questionnaire. RESULTS. Among 1809 study subjects, 79.2% chose radical prostatectomy (RP), 12.4% chose radiation therapy, and 8.4% chose watchful waiting (WW) as the ir decision regarding primary treatment. In bivariate analyses, education, income, age, indication for prostate biopsy, comorbidity scare, serum PSA l evel, clinical stage, and pretreatment urinary and sexual function were ass ociated significantly with treatment choice, but race, marital status, and Gleason grade were not. In a multivariate analysis, age, race, clinical sta ge, PSA level, and pretreatment urinary and sexual function were found to b e associated significantly with treatment choice. For every 5-year decrease in age, the adds for choosing RP versus WW increased by 276%; for every l- ng increase in PSA, the odds for choosing RP versus WW increased by 12%. No n-African-American patients were greater than four times more likely to sel ect RP versus WW. Patients with T2 tumors and those with normal pretreatmen t urinary function were three times more likely and twice more likely to ch oose RP versus WW, respectively. CONCLUSIONS. In the current study, RP was the most widely used treatment in patients with screen-detected prostate carcinoma. Age, race, PSA level, cl inical stage, and pretreatment urinary and sexual function were significant factors influencing treatment selection. (C) 2000 American Cancer Society.