Exploring value from the patient’s perspective between modern radiation therapy modalities for localized prostate cancer

Publication date: Available online 24 November 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Narek Shaverdian, Darlene Verruttipong, Pin-Chieh Wang, Amar U. Kishan, D Jeffrey Demanes, Susan McCloskey, Patrick Kupelian, Michael L. Steinberg, Christopher R. King
PurposeThe patient's perspective on their treatment experience has not been compared between modern radiation modalities for localized prostate cancer (PCa). We evaluated treatment regret and patient perceptions of their treatment experience to better inform our understanding of a treatment's value.Methods and MaterialsPatients with localized PCa treated with SBRT, IMRT or HDR Brachytherapy (HDR) between 2008-14 with at least one year of follow-up were surveyed. The questionnaire explored the decision-making experience, expectations of toxicities vs. the reality, and treatment regret via a validated tool.Results329 consecutive patients were surveyed with an 86% response rate (IMRT, n=74; SBRT, n=108; HDR, n=94). The median patient age and post-treatment follow-up was 68 years and 47 months, respectively. 82% of patients had T1c disease with either Gleason 6 (42%) or Gleason 7 (58%) pathology and a median iPSA of 5.8 ng/ml. 13% expressed regret with their treatment. Among patients with regret, 71% now wish they had elected for active surveillance. Incidence of regret was significantly different between treatment modalities: 5% of patients treated with SBRT expressed regret vs. 18% with HDR and 19% with IMRT (p<0.01). On multivariable logistic regression, patients treated with HDR vs. SBRT were 7.42 times more likely to have regret, and patients treated with IMRT vs. SBRT were 11.11 times more likely to have regret (p<0.01 and p<0.01, respectively). Significantly more patients treated with SBRT selected that their actual long-term toxicities were significantly less than originally expected compared with IMRT and HDR patients (SBRT 43% vs. IMRT 20% vs HDR 10%, p<0.01).ConclusionsWe found significant differences in the patient experience between SBRT, IMRT and HDR, with significantly less treatment regret and less toxicity than expected among SBRT patients. The majority of patients with regret would now opt for active surveillance, and therefore pre-treatment counseling is essential.



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