Preliminary Treatment Considerations Among Men With Newly Diagnosed Prostate Cancer

Objective: To assess factors that may influence men's preference for surgery versus nonsurgical options among newly diagnosed patients considering treatments for local-stage prostate cancer. Study Design: Prostate cancer patients were approached at urology clinics after diagnosis but prior to starting treatment in California, South Carolina, and Texas. Using a survey about the treatment decision-making process, patients were asked about their likes and dislikes of 5 common treatment options: surgery (prostatectomy), brachytherapy, external beam radiation therapy, hormone therapy, and watchful waiting. Methods: Logistic regression identified associations between treatment characteristics and choice of prostatectomy compared with nonsurgical options, controlling for demographic, clinical, and psychological covariates. Results: Of the 198 eligible men who returned the baseline survey, 59% indicated they only considered surgery and 41% considered at least 1 nonsurgical option. In multivariate analysis, patients who thought treatment efficacy was a primary concern were significantly more likely to prefer surgery only (odds ratio [OR] = 6.20, 95% confidence interval [95% CI] = 1.74, 22.10); those indicating concern about personal burden were significantly more likely to prefer nonsurgical options (OR = 0.07, 95% CI = 0.02, 0.22). Advice of friends and relatives and concerns over side effects were not significantly associated with preference for surgery versus other treatments. Conclusions: Men's perceptions about treatment efficacy and the personal burden of treatment dominated preferences for surgery versus nonsurgical options. Interventions to aid treatment decision making should account for these elements to minimize the impact of physician biases and patient misperceptions on men's decisions as how best to manage their prostate cancer. (Am J Manag Care. 2010; 16(5): e121-e130)