What Younger Men Choose, and Why

When it comes to prostate cancer, you're on the young side – age 47. You're otherwise healthy. Your cancer has been caught early, and is considered curable. This is a good problem to have. Now, the hard part: How should it be treated?

If you're having a tough time making this decision, you're not alone, and it may help to know how other guys in the same boat figure out what to do. Recently, an interdisciplinary group at the Brady, led by pathologist Jonathan Epstein, M.D., The Rose-Lee and Keith Reinhard Professor in Urologic Pathology, asked nearly 500 men under age 50, diagnosed with Gleason score 6 disease, about their treatment decision-making. The results of their study were published in the journal, Prostate. 

Out of 493 men, 81 percent (397) chose surgery; nearly 11 percent (52) chose radiation, and just over 5 percent (26) chose active surveillance. "We found that men with at least some college education or an annual income of $100,000 or greater were more likely to consult three or more doctors," notes Epstein. "Social support was very important. More than half of the patients consulted their family, spouses and friends before making their decision." The most influential source of information for these men was "doctor's recommendation," although this was of slightly less importance in the active surveillance group. Many men went online to do research, as well; the Internet was the second most frequent source of information.

How do other men decide 
which treatment is best?

"According to the patients, the most common reason to choose surgery over other forms of treatment was that it provided the best chance of cure," says Epstein, although "patients in our study reported their concern over side effects as the reason for choosing active surveillance." Men who chose radiation therapy cited its "less invasive nature" as their primary reason. Men with higher income and higher education also said they considered sexual function to be a more important factor in their treatment choice. 

Only 2 percent of the men in this study preferred to have a passive role in the decision- making. "Informed decision-making by myself based on information" was preferred more by men who chose radiation and active surveillance, while "shared decision-making between my physician and myself' was preferred more by surgery patients. 

Interestingly, the great majority – 89 percent – of the men in the study said they did not regret their decision. "We found no difference in satisfaction levels among the men in different treatment groups." Abhinav Sidana, David Hernandez, Zhaoyong Feng, Alan Partin, Bruce Trock, and Surajit Saha also participated in this research.

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