How men choose among prostate cancer treatments

Men diagnosed with localized prostate cancer have several treatment options. They include surgical removal of the cancer, external beam radiation, implanted radioactive seeds (brachytherapy), and freezing.

To date, no one of these treatments has been shown to offer better odds of long-term survival than the others. Each carries a risk of complications and a somewhat different
set of serious side effects.

Without guidance about the best way to treat early prostate cancer, not surprisingly, men will often make highly personal decisions. In addition to their concern over specific side effects (e.g., incontinence, impotence), men may be influenced by their fears and anxieties, the experience of friends, and information from a variety of sources, including the Internet.

To better understand men’s attitudes and how they think about the choices, a team of Denver researchers interviewed 20 men, average age 65, with localized prostate cancer. The interview took place shortly after each man’s first consultation with his urologist. Many were interviewed again 6 to 8 months after treatment. 

“Get it over with”
For most men, decision making occurred in a setting of fear and uncertainty. Despite being told that prostate cancer is typically slow-growing, more than half those interviewed were eager to begin treatment as soon as possible.

For one group (40%), surgery was the best option because it could be done quickly and because cutting the tumor out was the most tangible approach—simple common sense.

Surgery would also provide the most information about the cancer. Finding that it was in fact localized, the men (mistakenly) believed, would put an end to their fears. On the other hand, if it was discovered that the tumor had spread, then, they reasoned, “at least I’ll know what I’m dealing with.”

 “No knife for me”
On the other hand, the 55% of men who chose non-surgical treatments generally did so after first rejecting surgery. They found surgery to be drastic and “dreadful.” Some didn’t like the idea of being “put under” (anesthesia) and cut open, and feared dying on the operating table. In addition, some thought (wrongly) that surgery might spread the cancer.

As for the alternatives, many liked the idea of implanting radioactive seeds because the treatment was convenient, produced minimal side effects (they believed), and was the most “direct” approach. (Freezing is also direct, but it is experimental and was not widely available.) External beam radiation, by contrast, was considered less desirable because it was given daily over 6 weeks and caused considerable side effects.

Fear and friends
Although their urologists had reviewed the likelihood of experiencing side effects with each of the treatments, few of the men accurately recalled this information. None took it into account. In fact, about half the men minimized concern with side effects, saying they were unimportant compared to the risk of dying.

All but one man of the 20 interviewed knew firsthand or had heard about the cancer experiences of others. The stories of others strongly influenced the men’s decisions. They often ignored differences in the severity of others’ prostate cancer. They paid more attention to personal anecdotes than to objective information. 

And, 16 of the 20 men were not interested in getting a second opinion from another doctor. They often misunderstood the purpose of a second opinion. Moreover, some said they simply trusted their own urologist or didn’t want to risk being confused or delaying treatment.

Sources of information
When it came to obtaining information about treatment options, half preferred to rely on their doctors or immediate family to tell them what they needed to know. The other half sought information from other sources but often found themselves overwhelmed by contradictory and confusing advice.

For all the men, having to deal with a large amount of unfamiliar information was a major concern. Above all, they wanted a resolution of their crisis and an end to uncertainty.