Background
There are currently many treatment options available for men with prostate cancer, and it can be difficult for these men to choose which is the most appropriate.
Patients can experience regret about treatment choices made particularly when there are associated urinary, sexual or rectal function impairments, psychosocial effects, and cancer recurrence.
Regret about the way in which the treatment was chosen can also be experienced by patients.
Aim
To review papers that examined regret following treatment for localised prostate cancer and the factors associated with higher levels of regret, regret after specific treatments and the use of interventions to reduce regret.
Methods
Five online medical and psychological databases were searched with the terms ‘prostate’ and ‘regret’ in June 2014 for papers written in English and published from 1997 onward (when regret scales for prostate cancer patients were first developed).
The reference lists of included papers were also examined. Papers were eligible for review if they included participants with primarily localised prostate cancer and used quantitative research methods.
Results
The review included 28 papers containing data on a total of 8118 men.
Sixteen studies assessed factors associated with regret. The factors most frequently cited across the papers were associated with treatment toxicity; these included sexual dysfunction and urinary function, and to a lesser extent, bowel dysfunction.
Less frequently mentioned factors included non-White race, longer time since treatment and lower educational level. Strongly associated factors that were only mentioned in one paper included anxiety, cancer worry and lower income.
Twenty-one studies assessed levels of regret after a specific treatment. Levels of reported regret varied widely depending on the measure used.
The most common treatment comparison was radical prostatectomy (RP) versus external beam radiotherapy (EBRT) with one study showing higher regret with RP and the remaining six showing no significant differences.
The second most common comparison was RP versus brachytherapy (BT) with one study finding higher regret to be associated with RP but the other six studies reported no significant difference or did not report results by treatment separately.
Four studies compared a ‘wait and see’ approach to various treatments and found no significant difference in regret levels. Three studies compared open radical prostatectomy (ORP) to robotic-assisted laparoscopic radical prostatectomy (RALRP); one found significantly lower regret with ORP.
Five studies described interventions to modify levels of regret; three used decision aids and two used educational programs.
All studies, except one using a web-based decision support system, found significant lowering of regret levels after treatment when the intervention was applied prior to treatment decision making.
Conclusion
This is the first systematic review of studies examining regret after prostate cancer treatment.
The reviewers noted many limitations across the included papers including the use of widely differing scales to measure regret and different applications of these scales, lack of reporting on the absolute levels of regret (e.g. the mean regret value for each group), and the classification of patients into a single treatment option when in reality many would experience a combination of treatments.
Future research should use a standardized method of measuring regret. The findings of this review suggest that RP is associated with more regret than other treatment options (e.g. EBRT, BT), and that regret is likely to be reduced by the use of decision aids at the time of decision-making.
