Why patients choose prostatectomy or brachytherapy for localized prostate cancer: Results of a descriptive survey

Objectives. Limited data exist as to the reasons patients have for deciding among potentially curative treatment choices in clinically localized prostate cancer. Therefore, we carried out a descriptive pilot study to determine such motivations, sources of information, and other variables that influence how such patients choose between radical prostatectomy (RP) and brachytherapy (BT). Methods. Three hundred fifty-one men with clinically localized Stage T1c-T3 adenocarcinoma of the prostate were treated by RP or palladium-103 BT, either alone (BTM) or in combination with external radiotherapy (BTC). On June 1, 2000, patients were mailed a questionnaire, and cross-sectional analysis of the returned questionnaires was carried out. Results. Of 351 men, 262 (74.6%) responded to the survey; 65% chose treatment on the basis of evidence or an impression that it was the best procedure to cure their cancer. The possible side effects were also an important motivation for choosing a procedure. BTC patients listed the risk of urinary incontinence as the most disturbing and both RP and BTM patients listed sexual dysfunction. The most common unpleasant surprise for all treatment groups was bowel or bladder dysfunction. The most common pleasant surprise was a quick recovery. Urologists were the most important source of information and the major factor influencing the treatment decision. Surprisingly, spouses and fellow patients were relatively minor influences in this process. Conclusions. The results from this pilot study indicate that other factors beyond "cancer cure" are very important patient treatment decisions. In addition, by examining post-treatment "surprises," our data will allow the development of improved educational approaches to aid decision making.