Men's Perspectives on Selecting Their Prostate Cancer Treatment

• Published in: Journal of the National Medical Association Vol. 103; no. 6; pp. 468 - 479
• Main Authors: Xu, Jinping, MD, MS, Dailey, Rhonda K., MD, Eggly, Susan, PhD, Neale, Anne Victoria, PhD, MPH, Schwartz, Kendra L., MD, MSPH
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 01.06.2011; National Medical Association; Elsevier Limited
• Subjects: African Americans; Aged; Biological and medical sciences; Biomedical Technology; Choice Behavior; Culture; Directive Counseling - standards; European Continental Ancestry Group; General aspects; Gynecology. Andrology. Obstetrics; Humans; Internal Medicine; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Patient Participation - psychology; Patient-Centered Care - standards; Physician's Role - psychology; Physician-Patient Relations; Prostate - pathology; Prostate - radiation effects; Prostate - surgery; prostate cancer; Prostatectomy - psychology; Prostatectomy - trends; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - psychology; Prostatic Neoplasms - therapy; racial disparities; Radiotherapy - psychology; Self Concept; Social Support; treatment; Tumors; Tumors of the urinary system; United States; Urinary tract. Prostate gland; United States; racial disparities; treatment; prostate cancer; Human; Urinary system disease; Prostate disease; Male; Malignant tumor; Medicine; Perspective; Treatment; Race; Adult; Disparity; Male genital diseases; Prostate cancer; Cancer
• ISSN: 0027-9684; 1943-4693
• DOI: 10.1016/S0027-9684(15)30359-X

Objective In the context of scientific uncertainty, treatment choices for localized prostate cancer vary, but reasons for this variation are unclear. We explored how black and white American men made their treatment decision. Methods Guided by conceptual model, we conducted semi-structured interviews of 21 American (14 black and 7 white) men with recently diagnosed localized prostate cancer. Results Physician recommendation was very important in the treatment decision, but patient self-perception/values and attitudes/beliefs about prostate cancer were also influential. Patients who chose surgery believed it offered the best chance of cure and were more concerned that the cancer might spread if not surgically removed. Patients who chose radiation therapy believed it offered equal efficacy of cure but fewer side effects than surgery. Fear of future consequences was the most common reason to reject watchful waiting. Anecdotal experiences of family and friends were also important, especially in deciding "what not to do." The new technology of robotic-assisted prostatectomy provided optimism for men who wanted surgery but feared morbidity associated with traditional open surgery. Few men seemed aware that treatment did not guarantee improved survival. Conclusion Most men reported making "the best choice for me" by taking into account medical information and personal factors. Perceptions of treatment efficacy and side effects, which derived mainly from physicians' descriptions and/or anecdotal experiences of family and friends, were the most influential factors in men's treatment decision. By understanding factors that influence patients' treatment decisions, clinicians may be more sensitive to individual patients' preferences/concerns and provide more patient-centered care.