Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI.
Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
Urology. 2021 Sep;155:55-61. doi: 10.1016/j.urology.2021.04.020. Epub 2021 Apr 29.
To examine the relationship between influential factors and treatment decisions among men with newly diagnosed prostate cancer (PCa).
We identified men in the Michigan Urological Surgery Improvement Collaborative registry diagnosed with localized PCa between 2018-2020 who completed Personal Patient Profile-Prostate. We analyzed the proportion of active surveillance (AS) between men who stated future bladder, bowel, and sexual problems (termed influential factors) had "a lot of influence" on their treatment decisions versus other responses. We also assessed the relationship between influential factors, confirmatory testing results and choice of AS.
A total of 509 men completed Personal Patient Profile-Prostate. Treatment decisions aligned with influential factors for 88% of men with favorable risk and 49% with unfavorable risk PCa. A higher proportion of men who identified bladder, bowel and sexual concerns as having "a lot of influence" on their treatment decision chose AS, compared with men with other influential factors, although not statistically significant (44% vs 35%, P = .11). Similar results were also found when men were stratified based on PCa risk groups (favorable risk: 78% vs 67%; unfavorable risk: 17% vs 9%, respectively). Despite a small sample size, a higher proportion of men with non-reassuring confirmatory testing selected AS if influential factors had "a lot of influence" compared to "no influence" on their treatment decisions.
Men's concerns for future bladder, bowel, and sexual function problems, as elicited by a decision aid, may help explain treatment selection that differs from traditional clinical recommendation.
探讨新诊断前列腺癌（PCa）患者的影响因素与治疗决策之间的关系。
我们从密歇根州泌尿外科学术改进协作注册中心确定了 2018-2020 年间被诊断为局限性 PCa 且完成个人患者特征-前列腺评估的男性患者。我们分析了表示未来膀胱、肠道和性功能问题（称为影响因素）对其治疗决策“有很大影响”的男性与其他反应的男性之间主动监测（AS）的比例。我们还评估了影响因素、确认性检测结果与 AS 选择之间的关系。
共有 509 名男性完成了个人患者特征-前列腺评估。对于低危 PCa 患者，88%的治疗决策与影响因素一致；而对于高危 PCa 患者，49%的治疗决策与影响因素一致。与具有其他影响因素的男性相比，认为膀胱、肠道和性功能问题对其治疗决策有“很大影响”的男性选择 AS 的比例更高，尽管差异无统计学意义（44% vs 35%，P = 0.11）。当按 PCa 风险组对男性进行分层时，也得到了类似的结果（低危组：78% vs 67%；高危组：17% vs 9%）。尽管样本量较小，但与“无影响”相比，如果影响因素对其治疗决策“有很大影响”，则有更多非明确性确认性检测结果的男性选择 AS。
决策辅助工具中男性对未来膀胱、肠道和性功能问题的担忧可能有助于解释与传统临床建议不同的治疗选择。
