Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
BMC Urol. 2023 Aug 23;23(1):139. doi: 10.1186/s12894-023-01311-9.
Patients with localized prostate cancer (PC) are faced with a wide spectrum of therapeutic options at initial diagnosis. Following radical prostatectomy (RP), PC patients may experience regret regarding their initial choice of treatment, especially when oncological and functional outcomes are poor. Impacts of psychosocial factors on decision regret, especially after long-term follow-up, are not well understood. This study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP.
3408 PC survivors (mean age 78.8 years, SD = 6.5) from the multicenter German Familial PC Database returned questionnaires after an average of 16.5 (SD = 3.8) years following RP. The outcome of decision regret concerning the initial choice of RP was assessed with one item from the Decision Regret Scale. Health-related quality of life (HRQoL), PC-anxiety, PSA-anxiety, as well as anxiety and depressive symptoms were considered for independent association with decision regret via multivariable logistic regression.
10.9% (373/3408) of PC survivors reported decision regret. Organ-confined disease at RP (OR 1.39, 95%CI 1.02-1.91), biochemical recurrence (OR 1.34, 1.00-1.80), low HRQoL (OR 1.69,1.28-2.24), depressive symptoms (OR 2.32, 1.52-3.53), and prevalent PSA anxiety (OR 1.88,1.17-3.01) were significantly associated with increased risk of decision regret. Shared decision-making reduced the odds of decision regret by 40% (OR 0.59, 0.41-0.86).
PC survivors may experience decision regret even after 16 years following RP. Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret. Awareness regarding patients showing depressive symptoms or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.
局限性前列腺癌（PC）患者在初始诊断时面临广泛的治疗选择。根治性前列腺切除术（RP）后，PC 患者可能会对初始治疗选择感到后悔，尤其是当肿瘤学和功能结果不佳时。心理社会因素对决策后悔的影响，尤其是在长期随访后，尚不清楚。本研究旨在调查 RP 后长期 PC 幸存者决策后悔的发生率和决定因素。
来自多中心德国家族性 PC 数据库的 3408 名 PC 幸存者（平均年龄 78.8 岁，SD=6.5）在 RP 后平均 16.5（SD=3.8）年后返回问卷。通过决策后悔量表中的一个项目评估初始选择 RP 时的决策后悔结果。通过多变量逻辑回归，考虑健康相关生活质量（HRQoL）、PC 焦虑、PSA 焦虑以及焦虑和抑郁症状与决策后悔的独立关联。
3408 名 PC 幸存者中有 10.9%（373/3408）报告有决策后悔。RP 时器官受限疾病（OR 1.39，95%CI 1.02-1.91）、生化复发（OR 1.34，1.00-1.80）、HRQoL 低（OR 1.69，1.28-2.24）、抑郁症状（OR 2.32，1.52-3.53）和普遍存在的 PSA 焦虑（OR 1.88，1.17-3.01）与决策后悔的风险增加显著相关。共同决策使决策后悔的几率降低了 40%（OR 0.59，0.41-0.86）。
RP 后 16 年，PC 幸存者仍可能经历决策后悔。在初始诊断时，针对已建立的和新的、潜在侵袭性较小的治疗方法，提倡共同决策可能有助于减轻长期后悔。应鼓励关注表现出抑郁症状或 PSA 焦虑的患者，以识别需要额外心理支持的有决策后悔风险的患者。
