PURPOSE: Prostate cancer is the most common non-cutaneous cancer affecting men. Patients diagnosed with low-risk prostate cancer face the choice between treatment and active surveillance (AS). Increasing evidence indicates AS results in similar intermediate-term mortality and fewer side effects compared to active treatments. The fact that only 40% of patients in the US undergo AS raises the concern of the potential overtreatment of non-lethal cancer. The American Urological Association recommends shared decision-making with attention to patients’ treatment goals in this context. However, little is known about the influence of patient preferences for relevant treatment outcomes when patients make treatment decisions. This project aims to answer this question by analyzing the role of patient preferences in relation to other clinical factors in low-risk prostate cancer patients’ decision-making process.
METHODS: Patients with low-risk prostate cancer seen at UCLA Urology Clinic were offered a decisional aid that used conjoint analysis to assess their personal preferences prior to their cancer consults from 2013 to 2018. An electronic chart review was conducted to record their treatment decision, physician recommendation, comorbidities, and other clinical parameters. The importance of each of these factors in the patient’s decision-making process was evaluated in univariate analyses. Additionally, cluster analysis was used to examine if patients undergoing each treatment were associated with a preference phenotype.
RESULTS: A total of 80 low-risk prostate cancer patients completed the preference analysis throughout the study period. 46% decided to undergo active surveillance, 30% chose active treatment, and 24% were undecided. Factors including age, BMI, race, and comorbidities were not significantly associated with treatment decision. However, relationship status, physician recommendation and physician type were associated with different treatment decisions (p<0.05). Cluster analysis identified 2 clusters with distinct preference profiles. 30 patients were in cluster 1, out of which 60% chose active surveillance, 13% chose active treatment, and 27% were undecided. These patients generally prefer maintaining sexual function, maintaining urinary control, avoiding surgical complications and avoiding frequent urination. Among cluster 2, 38% out of 50 patients chose AS, 40% chose treatment, and 22% were undecided. These patients prefer avoiding impaired bowel functions, reduced longevity, frequent urinations and surgical complications.
CONCLUSIONS: Our study underscores the significant influence physician recommendation has in men deciding on low-risk prostate cancer treatments, overshadowing various clinical factors. Our study also indicates that patients are likely to undergo AS when AS is recommended by their physician but are not as likely to undergo active treatments when recommended. Additionally, men who strongly value sexual function higher than any other treatment outcomes are more likely to undergo active surveillance than those who highly ranked longevity. In future work, we hope to further define the relative importance of patient preferences and physician recommendations