Contemporary treatment decision-making at an equal access, multidisciplinary, prostate cancer clinic

A new paper in Urologic Oncology describes what appears to be one of the first prospective cohort studies to examine treatment decision-making by newly diagnosed prostate cancer patients within a contemporary, racially diverse, equal access, multidisciplinary clinic setting.

Hurwitz et al. report data from a prospective study conducted at Walter Reed National Military Medical Center (formerly the Walter Reed Army Medical Center). The study was initiated in 2006. It enrolled newly-diagnosed men with prostate cancer prior to their attendance at the center’s multidisciplinary prostate cancer clinic for counseling and discussion of their treatment options. All patients were asked to complete pre-clinic and post-clinic surveys to assess their treatment preferences, their reasons for treatment choice, and decisional regret.

Here are the core study findings:

  • 925 patients with prostate cancer had been enrolled as of January 2014.
  • For patients diagnosed with low- and intermediate-risk prostate cancer
    • 12 percent elected active surveillance.
    • 54 percent elected radical prostatectomy.
    • 20 percent elected external beam radiation therapy.
  • For patients diagnosed with high-risk prostate cancer
    • 34 percent elected radical prostatectomy.
    • 57 percent elected external beam radiation therapy + neoadjuvant androgen deprivation therapy.
  • Treatment choice was affected by age at diagnosis, race, comorbidity status, and calendar year (in univariable and in multivariable analyses).
  • Patients’ perceptions of the decision-making process at the multidisciplinary clinic included
    • Having the preferred ability to participate actively in the process
    • Finding the clinic physicians to be the most helpful source of treatment-related information
    • A very high level of satisfaction with their decision

The abstract of this paper does not provide us with detailed definitions of patient risk levels. Nor does it provide us with the average age (or the age range) of the patients involved. It is likely, however, that the patients studied may have been at the younger end of the prostate cancer age spectrum, given that Walter Reed is first and foremost a military care institution for those in active military service. This may also have some relevance to the relatively low numbers of men electing active surveillance for low-risk prostate cancer.

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