Document Detail


Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid.
MedLine Citation:
PMID:  22882966     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Study Type - Therapy (RCT) Level of Evidence 1b 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.
Authors:
Julia J van Tol-Geerdink; Jan Willem Leer; Philip C Weijerman; Inge M van Oort; Henk Vergunst; Emile N van Lin; J Alfred Witjes; Peep F Stalmeier
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-10
Journal Detail:
Title:  BJU international     Volume:  -     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.
Affiliation:
Departments of Radiation Oncology Urology Epidemiology, Biostatistics and HTA, Radboud University Medical Centre, Nijmegen Department of Urology, Rijnstate Hospital, Arnhem Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
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