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Long-Term Decision Regret After Radical Prostatectomy: Patient Survey Findings

By: Julia Fiederlein Cipriano, MS
Posted: Wednesday, October 4, 2023

Kathleen Herkommer, MD, MBA, of the Technical University of Munich, and colleagues conducted a cross-sectional cohort analysis to investigate whether prostate cancer survivors who underwent primary radical prostatectomy may experience treatment-related decision regret. Published in the journal BMC Urology, their findings confirmed a “considerable” prevalence of regret after more than 16 years of follow-up.

“Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret,” the investigators remarked. “Awareness regarding patients showing depressive symptoms or prostate-specific antigen [PSA] anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.”

A total of 3,408 prostate cancer survivors (median age, 78.8 years) from the multicenter German Familial Prostate Cancer Database completed questionnaires after an average of 16.5 years following radical prostatectomy. A single-item Decision Regret Scale was used to assess decision regret. The investigators performed multivariable logistic regression analyses to determine the association of selected sociodemographic, clinicopathologic, and psychological characteristics with decision regret.

Decision regret was reported by 10.9% of survivors. Organ-confined disease at radical prostatectomy (odds ratio [OR] = 1.39), biochemical recurrence (OR = 1.34), poor health-related quality of life (OR = 1.69), depressive symptoms (OR = 2.32), and prevalent PSA anxiety (OR = 1.88) were found to be significantly associated with an increased risk of decision regret. Shared decision-making resulted in an approximate 40% decrease in the likelihood of experiencing decision regret (OR = 0.59).

“To prevent and/or reduce decision regret in prostate cancer survivors, early intervention via patient education on all available treatments via shared decision-making should be promoted,” the study authors proposed. “This may be particularly important when choosing between definitive treatment versus active surveillance as an option.”

Disclosure: The study authors reported no conflicts of interest.

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