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Association of Pre-Existing Symptoms with Treatment Decisions among Newly Diagnosed Prostate Cancer Patients

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Abstract

Background: The choice between surgical and non-surgical treatment options is a fundamental decision for men with local-stage prostate cancer because of differences in risks of genitourinary adverse effects among available treatments.

Objectives: We assessed whether pre-existing genitourinary symptoms at the time of diagnosis influenced men’s preferences for surgery over other management options.

Methods: We recruited 593 patients with newly diagnosed local-stage prostate cancer prior to initiating treatment from an integrated healthcare system, an academic urology center, and community urology clinics. We used logistic regression to compare whether men had a preference for non-surgical options or only preferred surgery.

Results: Nearly 60% of participants indicated that they were considering non-surgical options. Age and clinical characteristics but not pre-existing genitourinary symptoms influenced the decision between surgical or non-surgical options. A total of 62% of men reported adverse effects as a main factor in their treatment decision. Men with more aggressive tumor types were less likely to consider adverse effects; however, men who reported poor ability to have an erection were more likely to consider adverse effects in their treatment decision (p < 0.001).

Conclusion: Sexual dysfunction at time of diagnosis, but not other genitourinary symptoms, is associated with men considering treatment-related adverse effects when considering surgery versus other options. Men who are not experiencing sexual dysfunction at diagnosis may discount the risks of adverse effects in the decision-making process.

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Acknowledgments

Work on this manuscript was supported by the National Cancer Institute contracts N01-PC-35142, N01-PC-35139, N01-PC-35136, and HHSN261200700321P. Case ascertainment for the focus group research was supported by the Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by contract no. N01-PC-35142 from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center and the State of Washington. The recruitment efforts in the Pacific Northwest region were made possible by independent urologists in community clinics throughout Washington (Centralia, Edmonds, Everett, Olympia, Port Angeles, Tacoma, Silverdale, Spokane) and Portland, OR.

The authors wish to thank the following people for their significant contributions to this work in the areas of data collection or analysis: Norma Caldera, Mary Lo, Tracy Paz (USC); Brenna McGee, Amethyst Leimpeter, Jun Shan (KPNC); Sarah Shema (NCCC); Megan Fairweather and Catherine Fedorenko (FHCRC).

The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

    Steven B. Zeliadt & Scott D. Ramsey

  2. Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA

    Arnold L. Potosky

  3. National Cancer Institute, Bethesda, Maryland, USA

    Neeraj K. Arora

  4. University of Washington, Seattle, Washington, USA

    David K. Blough

  5. Northern California Cancer Center, Fremont, California, USA

    Ingrid Oakley-Girvan

  6. Keck School of Medicine, University of Southern California, Los Angeles, California, USA

    Ann S. Hamilton

  7. Kaiser Permanente, Oakland, California, USA

    Stephen K. Van Den Eeden

  8. University of Southern California/Norris Cancer Center, Los Angeles, California, USA

    David F. Penson

Authors
  1. Steven B. Zeliadt
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  2. Scott D. Ramsey
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  7. Ann S. Hamilton
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Correspondence to Scott D. Ramsey.

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Zeliadt, S.B., Ramsey, S.D., Potosky, A.L. et al. Association of Pre-Existing Symptoms with Treatment Decisions among Newly Diagnosed Prostate Cancer Patients. Patient-Patient-Centered-Outcome-Res 1, 189–200 (2008). https://doi.org/10.2165/1312067-200801030-00006

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  • DOI: https://doi.org/10.2165/1312067-200801030-00006

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