Patients Who Play Active Role in Prostate Cancer Surgery Decisions Less Likely to Experience Regret

Men with localized prostate cancer, regardless of whether they chose traditional or robotic surgery, had very little long-term decision regret, according to data from the HAROW study published in The Journal of Urology.

“Decision-related regret is a negative emotion associated with thinking about a past choice and comparing the status quo with a hypothetical situation which might have taken place with having chosen a different treatment alternative,” the researchers wrote.

Previous studies that were considered controversial, according to the researchers, have not demonstrated any difference in decision regret among treatment options. For instance, patients did not have greater decision regret after radical prostatectomy than after radiotherapy or brachytherapy.

As treatment options have advanced, the hope was to improve patient outcomes and treatment satisfaction.

The goal of this study was to evaluate patient decision making and decision regret within six years after open radical prostatectomy (ORP) versus robot-assisted radical prostatectomy (RARP). In ORP, a surgeon makes one long incision to remove the prostate. In RARP, the prostate is pulled through one of several small abdominal incisions using robotic operating tools controlled remotely by a surgeon.

The study included 936 patients who received either ORP (532) or RARP (404) in Germany from 2008 to 2013.

Patients who received RARP were more likely to research their treatment options and more actively selected the hospital in which their procedure would take place. Additionally, patients who received RARP were more likely to select hospitals that performed more prostate cancer-related surgeries and to travel longer distances to the hospital. In general, those patients reported having a more active role in both the surgical decision and approach.

Decision regret — ranked on a scale of 0 to 100 — was low, with a mean score of 14, and there was no significant difference in decision regret between the two surgical approaches.

Predictors of low decision regret, which was defined as a score of less than 15, included improved erectile function, urinary continence, no cancer recurrence, an active role in deciding surgical treatment and shorter follow-up.

“To our knowledge, this is the first study of decision regret in a large and moderately selected cohort undergoing routine care with an intermediate-term follow-up of six years,” the researchers wrote.

There were, however, some limitations to the data, according to the researchers.

“There was selection bias concerning the surgical procedure, which is inherent in the German health care system,” the researchers wrote. “As in many other countries, robotic surgery is performed more often at high-volume hospitals due to high investment costs ... Multivariate analyses showed no independent association of surgical approach with decision regret or functional and oncologic outcomes.”