Determinants of treatment decisions in newly diagnosed prostate cancer patients

Background and objectives

Patients with newly diagnosed prostate cancer (PCA) face the critical decision of whether to undergo treatment with curative intent (TCI, surgery or radiation) or conservative treatment on the background of a cancer where the potential for over-treatment and under-treatment is real. This study aimed to investigate the influence of cancer- and patient-related factors on the initial treatment decision for men with a new diagnosis of PCA and to evaluate treatment decisions against relevant guidelines.

Methods

This study undertook a retrospective audit of the clinical records of 545 men who were diagnosed with PCA at four Australian urology services. Age, comorbidities, and cancer-related factors were recorded, with patients divided into risk groups based on cancer factors.

Results

Cancer risk stratification emerged as a primary determinant influencing individual treatment choices, with low-risk patients being more likely to have active surveillance and those classified as intermediate or high-risk being more likely to have TCI. Surgery was more commonly offered to younger patients and those with fewer comorbidities. While 80% of patients received guideline-concordant treatment, 20% were identified as being over-treated, receiving TCI despite limited life expectancy and/or high comorbidities.

Conclusions

The aim in treating men diagnosed with PCA should be to avoid under-treatment in men who are young, healthy, and have aggressive cancer by offering TCI. Conversely, over-treatment or unnecessary treatment should be avoided in men with low-grade cancer or in those who are likely to die from competing causes rather than from PCA because of limited life expectancy or significant comorbidities. The results of the current study demonstrated that 80% of patients treated by the participating urologists received appropriate treatment according to the AUA/ASTRO guidelines. Ultimately cancer factors are the prime determinants of treatment options and can be modified by life expectancy and comorbidities. Physicians must be careful not to overestimate the lethality of cancer and underestimate the potential for age and comorbidities to be more likely causes of death while still offering TCI to those most likely to benefit.

Source:
Journal reference:

Skyring, T. A., et al. (2024). Risk of Under-treatment and Over-treatment in a Group of Australian Men Diagnosed with Prostate Cancer. Cancer Screening and Prevention. doi.org/10.14218/CSP.2023.00029.

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