Association of Pre-Existing Symptoms with Treatment Decisions among Newly Diagnosed Prostate Cancer Patients
Steven B. Zeliadt
Scott D. Ramsey
Arnold L. Potosky
Neeraj K. Arora
David K. Blough
Ann S. Hamilton
Stephen K. Van Den Eeden
David F. Penson
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. DOI: 10.2165/1312067-200801030-00006
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