Regret post-treatment in men with pre-existing cardiovascular disease

Another newly published paper, this time in the British Journal of Urology, addresses issues related to cardiovascular disease and the treatment of prostate cancer. However, in this case it is about the treatment of men who had an existing cardiovascular condition at the time of their initial treatment.

In this paper, Nguyen et al. sought to explore specifically whether cardiovascular comorbidity is associated with treatment regret among men with recurrent prostate cancer after first-line therapy. it has previously been demonstrated that treatment regret is associated with a lower level of educational attainment, non-White race, greater post-treatment declines in sexual function, and systemic symptoms.

Treatment regret can have an adverse impact on a patient’s overall outlook and has been associated with a poorer global quality of life. Understanding predictors of regret can help clinicians better counsel patients about their treatments so that later regret can be avoided. In previous studies, regret has been

The study was based on a retrospective analysis of data from 795 men enrolled in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry. All patinets had a biochemical recurrence at an average (median) of 5.5 years after prostatectomy (n = 410), external beam radiation therapy (n = 237), brachytherapy (n = 124) or primary androgen deprivation therapy (n = 24).
The authors were able to show that:
  • 14.8 percent of the patient cohort reported regret.
  • Patients with pre-existing cardiovascular comorbidity were more likely to experience post-therapy bowel toxicity (P = 0.022).
  • The factors significantly associated with increased treatment regret were
    • Cardiovascular comorbidity (adjusted odds ratio [AOR] = 1.52)
    • Younger age (AOR = 0.97 per year increase in age)
    • Bowel toxicity post-treatment (AOR = 1.58)
The authors conclude that the patients with pre-existing cardiovascular comorbidities were > 50 percent more likely to experience treatment regret than men without cardiovascular comorbidity, and that these data suggest that men with pre-existing cardiovascular comorbidities give additional consideration to active surveillance as a first-line form of management for newly diagnosed prostate cancer.
A further discussion of this paper on the Reuters web site provides supplementary information. In that discussion, Dr. Timothy Showalter, a radiation oncologist at Jefferson Medical College in Philadelphia who was not involved in the research is quoted as stating that “We’ve known for a while that men with other medical problems, like heart disease, may get a smaller benefit from radiation or surgery.” He want on to say that this study represents “another piece of evidence that supports closely monitoring men with prostate cancer” as opposed to implementing immediate treatment.

As noted by Reuters, “The study doesn’t show why patients with heart problems had more second thoughts about their treatment.” One possibility noted by the study’s lead author is that “men dealing with other diseases may not be able to cope with the extra distress from cancer treatment.”

It is important to note that this study only addresses regret in men who had a biochemical recurrence after first-line treatment and not all patients receiving first-line treatment for prostate cancer. As Dr. Nguyen is also quoted as saying, “This study tells men who have other diseases that maybe they should take a step back and not treat the cancer right away.”

One Response

  1. Regret, like satisfaction, almost surely reflects personality and coping styles. It may be that regretful patients with heart disease who are considering prostate cancer treatment will be even more regretful if they forgo prostate cancer treatment. This, alas, is the deficiency of retrospective analyses. What seems clearly apparent, however, is that prostate cancer diagnosis occurs in a varied and potentially problematic psycho-social environment. This points to the need to attend to the many dimensions of health that patients present, including the emotional.

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