Guy's and St Thomas' NHS Trust, London, UK.
Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK; Division of Surgery and Interventional Sciences, University College London, London, UK.
Eur Urol Oncol. 2023 Oct;6(5):456-466. doi: 10.1016/j.euo.2023.02.005. Epub 2023 Mar 3.
Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to conflict and regret. There is a need to further understand the prevalence and prognostic factors of decision regret to improve patient quality of life.
To generate the best estimates for the prevalence of significant decision regret localised prostate cancer patients, and to investigate prognostic patient, oncological, and treatment factors associated with regret.
We performed a systematic search of MEDLINE, Embase, and PsychINFO databases including studies evaluating the prevalence or patient, treatment, or oncological prognostic factors in localised prostate cancer patients. A pooled prevalence of significant regret was calculated with the formal prognostic factor evaluation conducted per factor identified.
Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17883 patients. This was lower in active surveillance (13%), with little difference between those who underwent radiotherapy (19%) and those who underwent prostatectomy (18%). Evaluation of individual prognostic factors demonstrated higher regret in those with poorer post-treatment bowel, sexual, and urinary function; decreased involvement in the decision-making process; and Black ethnicity. However, evidence remains conflicting, with low or moderate certainty of findings.
A significant proportion of men experience decision regret after a localised prostate cancer diagnosis. Monitoring those with increased functional symptoms and improving patient involvement in the decision-making process through education and decision aids may reduce regret.
We looked at how common regret in treatment decisions is after treatment for early-stage prostate cancer and factors linked with this. We found that one in five regret their decision, with those who had experienced side effects or were less involved in the decision-making process more likely to have regret. By addressing these, clinicians could reduce regret and improve quality of life.
局限性前列腺癌的治疗选择仍然是患者和临床医生面临的重大挑战，决策中的不确定性可能导致冲突和遗憾。因此，需要进一步了解决策后悔的普遍性和预后因素，以提高患者的生活质量。
评估局限性前列腺癌患者显著决策后悔的患病率，并探讨与后悔相关的患者、肿瘤学和治疗因素。
我们对 MEDLINE、Embase 和 PsychINFO 数据库进行了系统检索，包括评估局限性前列腺癌患者的患病率或患者、治疗或肿瘤学预后因素的研究。对每个确定的因素进行正式预后因素评估后，计算了显著后悔的合并患病率。
14 项研究共纳入 17883 例患者，汇总分析显示，20%（95%置信区间 16-23）的患者存在显著决策后悔。在主动监测组（13%）中，这一比例较低，接受放疗（19%）和前列腺切除术（18%）的患者之间差异不大。对个别预后因素的评估表明，治疗后肠道、性功能和尿功能较差、参与决策过程较少以及黑人种族的患者后悔程度更高。然而，证据仍然存在争议，其确定性为低或中。
在局限性前列腺癌诊断后，相当一部分男性会对治疗决策感到后悔。通过监测那些有更多功能症状的患者，并通过教育和决策辅助工具提高患者在决策过程中的参与度，可以减少后悔。
我们研究了早期前列腺癌治疗后治疗决策后悔的常见程度以及与这种情况相关的因素。我们发现，五分之一的患者后悔自己的决定，那些经历过副作用或较少参与决策过程的患者更有可能感到后悔。通过解决这些问题，临床医生可以减少后悔，提高生活质量。
