Decisional Regret Among Men With Prostate Cancer

Jones, Randy

doi:10.1001/jamaoncol.2021.5137

Cited by 3 publications

(7 citation statements)

References 10 publications

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“…Such decision making is especially important in the context of advanced disease, where the survival benefit of local treatment may not be substantial. Indeed, treatment-related decisional regret among patients with PCa is common when patient expectations and experiences are misaligned . Our results suggest that patients and clinicians should carefully consider potential treatment-related adverse effects, especially because there are currently no established guidelines regarding the use of local treatment among men with advanced PCa.…”

Section: Discussionmentioning

confidence: 88%

Local Treatment and Treatment-Related Adverse Effects Among Patients With Advanced Prostate Cancer

Khan,

Chang,

Wang

et al. 2023

JAMA Netw Open

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ImportanceRecent data suggest that local treatment with radical prostatectomy or radiation may improve survival outcomes in men with advanced prostate cancer. However, evidence is lacking on treatment-related adverse effects among men with advanced prostate cancer.ObjectiveTo assess the association of local treatment on treatment-related adverse effects among men diagnosed with advanced prostate cancer.Design, Setting, and ParticipantsThis cohort study assessed men diagnosed with advanced prostate cancer (defined as T4, N1, and/or M1 prostate cancer) between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2021, who were treated at Veterans Health Administration medical centers.ExposureLocal treatment with radical prostatectomy or radiation.Main Outcomes and MeasuresMain outcomes were treatment-related adverse effects, including constitutional, gastrointestinal, pain, sexual function, and urinary function conditions, at 3 intervals after initial treatment (≤1 year, &gt;1 to ≤2 years, and &gt;2 to ≤5 years) after initial treatment.ResultsThis cohort study consisted of 5502 men (mean [SD] age, 68.7 [10.3] years) diagnosed with advanced prostate cancer. Of the cohort, 1705 men (31.0%) received local treatment. There was a high prevalence of adverse conditions in men receiving both local and nonlocal treatment, and these adverse conditions persisted for more than 2 years to 5 years or less after initial treatment. A total of 916 men (75.2%) with initial local treatment and 897 men (67.1%) with initial nonlocal treatment reported the presence of at least 1 adverse condition for more than 2 years to 5 years or less after initial treatment. In the first year, local treatment (vs nonlocal) was associated with adverse gastrointestinal (multivariable-adjusted odds ratio [AOR], 4.08; 95% CI, 3.06-5.45), pain (AOR, 1.57; 95% CI, 1.35-1.83), sexual (AOR, 2.96; 95% CI, 2.42-3.62), and urinary (AOR, 2.25; 95% CI, 1.90-2.66) conditions. Local treatment (without secondary treatment) remained significantly associated with adverse gastrointestinal (AOR, 2.39; 95% CI, 1.52-3.77), sexual (AOR, 3.36; 95% CI, 2.56-4.41), and urinary (AOR, 1.39; 95% CI, 1.09-1.78) conditions at more than 2 years to 5 years or less after treatment.Conclusions and RelevanceIn this cohort study of men with advanced prostate cancer, local treatment was associated with persistent treatment-related adverse effects across multiple domains. These results suggest that patients and clinicians should consider the adverse effects of local treatment when making treatment decisions in the setting of advanced prostate cancer.

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Section: Discussionmentioning

confidence: 88%

Local Treatment and Treatment-Related Adverse Effects Among Patients With Advanced Prostate Cancer

Khan,

Chang,

Wang

et al. 2023

JAMA Netw Open

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“…In JAMA Oncology, Jones et al 9 reported on the feasibility and tumor biological response of neoadjuvant exercise therapy in men diagnosed with localized prostate cancer. In this singlecenter phase 1a nonrandomized trial, 53 sedentary patients with localized prostate cancer scheduled for prostatectomy were enrolled in an intervention where they were allocated to 6 escalated exercise therapy sessions that varied by the number of minutes per session and the total number of minutes per week.…”

mentioning

confidence: 99%

“…Despite the noteworthy goals of the trial led by Jones and colleagues, 9 weaknesses in the study design, patient recruitment, data collection, and end points selected may limit the usefulness of the results. First, presurgical interventions in patients with prostate cancer are scientifically intriguing due to the ready availability of presurgical and postsurgical tissue for scientific interrogation, but they are very challenging to execute in a standardized manner.…”

mentioning

confidence: 99%

“…Second, while Jones et al 9 are to be commended for designing a study with minimal participation barriers and good retention rates, challenges in recruitment were evident with the 9.8% enrollment rate from among the 1550 patients who were screened for eligibility over a lengthy period of 3.5 years. This protracted accrual time raises concerns not just about the generalizability of findings, but also concerning recruitment for future studies and wider adoption of any proposed standardized intervention.…”

mentioning

confidence: 99%

“…12 How do we move the field forward both to determine the most effective exercise doses for patients with prostate cancer and to understand better the biological mechanisms underlying a tumor response? Jones et al 9 are on the right path in terms of designing a decentralized trial that may improve access to participation. It is also a laudable goal to test various escalated doses of physical activity intensity to determine the most feasible regimen to move forward into future trials.…”

mentioning

confidence: 99%

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