Treatment decisions for localized prostate cancer - Asking men what's important

OBJECTIVE: To identify what factors men consider important when choosing tr eatment for prostate cancer, and to assess why men reject watchful waiting as a treatment option. PARTICIPANTS: One hundred two consecutive men with newly diagnosed localize d prostate cancer identified from hospital and community-based urology prac tice groups. MEASUREMENTS: Patients were asked open-ended questions about likes and disl ikes of all treatments considered, how they chose their treatment, and reas ons 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 o f 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 in = continence for RP (n = 46), long duration of therapy for EBRT (n = 29), an d 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 com mon reason to reject watchful waiting. CONCLUSION: In discussing treatment options for localized prostate cancer, clinicians, including primary care providers, should recognize that patient s' decisions are often based on specific beliefs regarding each therapy's i ntrinsic 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 consequen ces.