Active Role in Decision Making for Prostate Cancer Surgery Leads to Less Decision Regret

According to a study published in The Journal of Urology, patients who have a more active role in making decisions about their prostate cancer surgery tend to be less likely to experience “decision regret” about their choices.¹

The researchers also found no association between the surgical approach and decision regret.

“Decision related regret is a negative emotion associated with thinking about a past choice and comparing the status quo with a hypothetical situation which might have taken place with having chosen a different treatment alternative,” the authors wrote. 

Using intermediate term follow up data on 1,260 patients from the HAROW study, which evaluated localized prostate cancer treatments in Germany from 2008 to 2013, patients were asked to rate their “distress or remorse” about their treatment choice using a 0 to 100 Decision Regret Scale. The response rate was 76.8% (936 of 1,218 patients). 

“The name HAROW refers to the major treatment options for patients with this diagnosis – namely hormone therapy, active surveillance, radiation, operation (surgery), or watchful waiting,” study coauthor Lothar Weissbach, MD, founder of the HAROW project, said in a press release.²

Of the responding cohort, 404 patients underwent robot-assisted radical prostatectomy and 532 underwent open radical prostatectomy. Researchers found that men treated with a robot-assisted procedure showed more self-determined behavior. Those who underwent robot-assisted radical prostatectomy and open radical prostatectomy reported to have an active role in surgical decision making (39% vs 24%, respectively; P < 0.001) and the surgical approach (52% vs 18%; P < 0.001). Additionally, patients treated with the robot-assisted procedure more often participated actively in selecting the treating hospital (25% vs 11%; P < 0.001), used the Internet frequently (87% vs 72%; P < 0.001), and traveled a further distance for treatment (63 vs 42 km; P < 0.001). 

Overall, decision regret was low with a mean ± SD score of 14 ± 19. Multivariate analysis indicated that erectile function (odds ratio [OR], 3.2), urinary incontinence (OR, 1.8), freedom from recurrence (OR, 1.6), an active decision making role (OR, 2.2) and shorter follow up (OR, 0.9 per year) predicted low decision regret (a score less than 15). 

“Patients diagnosed with localized prostate cancer are confronted with a series of treatment options,” the authors wrote. “However, the personal role in decision making is important when coping with treatment decisions in persons with serious illness.”

However, researchers suggested that it is unclear as to whether an active role in treatment decision making is an individual thought process or if it can be influenced or shaped by decision aids or counseling. 

Though a bias may exist within the study, as some patients may have been admitted to a hospital without robotic approach options, actively involved patients might choose another hospital if they have a strong desire for robotic surgery. Moreover, the researchers noted that an overly optimistic presentation of the robotic approach could be driven by media coverage and its economic importance as a competitive advantage across hospitals. 

Though numerous studies have compared the surgical, oncologic, and functional outcomes of prostate cancer treatment, this was the first study of decision regret in a large and moderately selected cohort undergoing routine care with an intermediate term follow up of 6 years. 

References:

1. Baunacke M, Schmidt M, Groeben C, et al. Decision Regret after Radical Prostatectomy does Not Depend on Surgical Approach: 6-Year Followup of a Large German Cohort Undergoing Routine Care. The Journal of Urology. doi:10.1097/JU.0000000000000541.

2. Most Men Do Not Regret their Choices for Prostate Cancer Surgery [news release]. Wolters Kluwer Health: Lippincott Williams and Wilkins. Published February 10, 2020. newswise.com/articles/most-men-do-not-regret-their-choices-for-prostate-cancer-surgery?sc=mwhr&xy=10021790. Accessed February 18, 2020.