Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid

• Published in: BJU international Vol. 111; no. 4; pp. 564 - 573
• Main Authors: Tol‐Geerdink, Julia J., Willem Leer, Jan, Weijerman, Philip C., Oort, Inge M., Vergunst, Henk, Lin, Emile N., Alfred Witjes, J., Stalmeier, Peep F.
• Format: Journal Article
• Language: English
• Published: Oxford Wiley-Blackwell 01.04.2013
• Subjects: Aged; Biological and medical sciences; Choice Behavior; decision aid; Decision Support Techniques; Disease-Free Survival; Gynecology. Andrology. Obstetrics; Humans; informed choice; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Nephrology. Urinary tract diseases; Netherlands; Patient Participation; patient preference; Patient Preference - statistics & numerical data; Patient Selection; Prognosis; Prospective Studies; prostate cancer; Prostatectomy - methods; Prostatectomy - mortality; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiotherapy, Conformal - methods; Radiotherapy, Conformal - mortality; Risk Assessment; Survival Rate; treatment choice; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Netherlands; Participation; Nephrology; Choice; Prostate disease; informed choice; patient participation; Male; Urology; Surgery; Decision aid; Adult; Male genital diseases; Human; Urinary system disease; treatment choice; Malignant tumor; Radiotherapy; Randomized controlled trial; Care; patient preference; Treatment; Preference; Prostatectomy; Prostate cancer; Comparative study; Cancer
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2012.11402.x

What's known on the subject? and What does the study add? Many patients are eligible for more than one treatment option for prostate cancer. In usual care, urologists have a large influence on the treatment choice. Decision aids, providing balanced information on the pros and cons of different treatment options, improve the match between patient preferences and treatment received. In men eligible for both surgery and external beam radiotherapy, treatment choice differed by hospital. Across the participating hospitals, the decision aid consistently led to fewer patients remaining undecided on their treatment preference and more patients choosing brachytherapy. Objectives To examine the treatment choice for localized prostate cancer in selected men who were eligible for both prostatectomy and radiotherapy. To examine whether increased patient participation, using a decision aid, affected the treatment choice. Patients and Methods From 2008 to 2011, 240 patients with localized prostate cancer were enrolled from three separate hospitals. They were selected to be eligible for both prostatectomy and external beam radiotherapy. Brachytherapy was a third option for about half of the patients. In this randomized controlled trial, patients were randomized to a group which only discussed their treatment with their specialist (usual care group) and a group which received additional information from a decision aid presented by a researcher (decision aid group). The decision aid was based on a literature review. Predictors of treatment choice were examined. Results Treatment choice was affected by the decision aid (P = 0.03) and by the hospital of intake (P < 0.001). The decision aid led to more patients choosing brachytherapy (P = 0.02) and fewer patients remaining undecided (P < 0.05). Prostatectomy remained the most frequently preferred treatment. Age, tumour characteristics or pretreatment urinary, bowel or erectile functioning did not affect the choice in this selected group. Patients choosing brachytherapy assigned more weight to convenience of the procedure and to maintaining erectile function. Conclusions Traditionally, patient characteristics differ between surgery and radiotherapy groups, but not in this selected group of patients. Men eligible for both prostatectomy and radiotherapy mostly preferred prostatectomy, and the treatment choice was influenced by the hospital they visited. Giving patients evidence‐based information, by means of a decision aid, led to an increase in brachytherapy.