Original Research Article

The Patient: Patient-Centered Outcomes Research

, Volume 1, Issue 3, pp 189-200

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

  • Steven B. ZeliadtAffiliated withFred Hutchinson Cancer Research Center
  • , Scott D. RamseyAffiliated withFred Hutchinson Cancer Research Center Email author 
  • , Arnold L. PotoskyAffiliated withLombardi Comprehensive Cancer Center, Georgetown University Medical Center
  • , Neeraj K. AroraAffiliated withNational Cancer Institute
  • , David K. BloughAffiliated withUniversity of Washington
  • , Ingrid Oakley-GirvanAffiliated withNorthern California Cancer Center
  • , Ann S. HamiltonAffiliated withKeck School of Medicine, University of Southern California
  • , Stephen K. Van Den EedenAffiliated withKaiser Permanente
  • , David F. PensonAffiliated withUniversity of Southern California/Norris Cancer Center

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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.