Journal of General Internal Medicine

, Volume 15, Issue 10, pp 694–701

Treatment decisions for localized prostate cancer

Asking men what’s important
Original Articles


OBJECTIVE: To identify what factors men consider important when choosing treatment for prostate cancer, and to assess why men reject watchful waiting as a treatment option.

PARTICIPANTS: One hundred two consecutive men with newly diagnosed localized prostate cancer identified from hospital and community-based urology practice groups.

MEASUREMENTS: Patients were asked open-ended questions about likes and dislikes of all treatments considered, how they chose their treatment, and reasons 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 of 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 incontinence for RP (n=46), long duration of therapy for EBRT (n=29), and 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 common reason to reject watchful waiting.

CONCLUSION: In discussing treatment options for localized prostate cancer, clinicians, including primary care providers, should recognize that patients’ decisions are often based on specific beliefs regarding each therapy’s intrinsic 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 consequences.

Key words

localized prostate cancer treatment decision making 


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  1. 1.
    Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1998. CA Cancer J Clin. 1995;48:6–29.Google Scholar
  2. 2.
    Woolf SH. Screening for prostate cancer with prostate-specific antigen. N Engl J Med. 1995;333:1401–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Dorr VJ, Williamson SK, Stephens RL. An evaluation of prostatespecific antigen as a screening test for prostate cancer. Arch Intern Med. 1993;153:2529–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Perkins T. Concern grows over prostate cancer treatment options. JNCI. 1994;86:987–8.Google Scholar
  5. 5.
    Menon M, Parulker BG, Baker S. Should we treat localized prostate cancer. An opinion. Urology. 1995;46:607–15.PubMedCrossRefGoogle Scholar
  6. 6.
    Walsh PC. The natural history of localized prostate cancer: a guide to therapy. In: Walsh PC, Retik AB, Vaughn ED, Wen AJ, eds. Campbell’s Urology. Philadelphia, PA: W.B. Saunders; 1998:2539–44.Google Scholar
  7. 7.
    Hahn DL, Roberts RG. Screening for asymptomatic prostate cancer: truth in advertising. J Fam Pract. 1993;37:432–6.PubMedGoogle Scholar
  8. 8.
    Litwin MS, Hays RD, Fink A., et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. 1995;273:129–35.PubMedCrossRefGoogle Scholar
  9. 9.
    Andriole GL, Smith DS, Rao G, Goodnough L, Catalona WJ. Early complications of contemporary anatomical radical retropubic prostatectomy. Urology. 1994;152(5 Pt 2):1858–60.Google Scholar
  10. 10.
    Fowler FJ, Roman A, Barry MJ, Wasson J, Lu-Yao G, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy. The national Medicare experience: 1988–1990. Urology. 1993;42:622–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Garnick MB, Fair WR. Prostate cancer: emerging concepts. Part I. Ann Intern Med. 1996;125:118–25.PubMedGoogle Scholar
  12. 12.
    Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wennberg JE. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA 1993;269:2650–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Schroder FH. Screening, early detection, and treatment of prostate cancer: a European view. Urology. 1995;46:62–70.PubMedCrossRefGoogle Scholar
  14. 14.
    Graverson PH, Nielsen KT, Gasser TC, Corle DK, Madsen PO. Radical prostatectomy versus expectant primary treatment in stages I and II prostatic cancer. A fifteen year follow-up. Urology. 1990;36:493–8.CrossRefGoogle Scholar
  15. 15.
    Middleton RG, Thompson IM, Austenfeld MS, et al. Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association. J Urol. 1995;154:2144–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Saltus R. For prostate cancer there’s no magic bullet. Boston Globe. January 12, 1998:C1.Google Scholar
  17. 17.
    Schapira MM, Nattinger AB, Katz DA, Lawrence W. Information seeking and satisfaction with treatment decision in patients with clinically localized prostate cancer. Med Decis Making. 1997;17(suppl):544. Abstract.Google Scholar
  18. 18.
    Fowler FJ, Bin L, Collins MM, et al. Prostate cancer screening and beliefs about treatment efficacy: a national survey of primary care physicians and urologists. Am J Med. 1998;104:526–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Feinstein AR. Clinimetrics. New Haven: Yale University Press; 1987.Google Scholar
  20. 20.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRefGoogle Scholar
  21. 21.
    D’Amico AV, Coleman CN. Role of interstitial radiotherapy in the management of clinically organ-confined prostate cancer: the jury is still out. J Clin Oncol. 1996;14:304–15.PubMedGoogle Scholar
  22. 22.
    Slovic P. Perception of risk. Science. 1987;236:280–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Kattan MW, Cowen ME, Miles BJ. A decision analysis for treatment of clinically localized prostate cancer. J Gen Intern Med. 1997;12:299–305.PubMedCrossRefGoogle Scholar
  24. 24.
    Johansson JE. Watchful waiting for early stage prostate cancer. Urology. 1994;43:138–42.PubMedCrossRefGoogle Scholar
  25. 25.
    Sandhu SS, Kaisary AV. Localised carcinoma of the prostate: a paradigm of uncertainty. Postgrad Med J. 1996;73:691–6.Google Scholar
  26. 26.
    Chodak GW. The role of watchful waiting in the management of localized prostate cancer. J Urol. 1994;152:1766–8.PubMedGoogle Scholar
  27. 27.
    Steinberg GD, Bales GT, Brendler CB. An analysis of watchful waiting for clinically localized prostate cancer. J Urol. 1998;159:1431–6.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  1. 1.the Division of General MedicineNational Naval Medical CenterBethesda
  2. 2.Clinical Epidemiology UnitWest Haven Veterans Affairs Medical CenterWest Haven
  3. 3.Department of Medicine and the Robert Wood Johnson Clinical Scholars ProgramYale University School of MedicineNew Haven
  4. 4.Rockville

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