1.Decisional Trade-offs in Localized Prostate Cancer: A Prospective Cross-Sectional Study of Radical Prostatectomy, Radiation Therapy, and Active Surveillance
Hyunho HAN ; Youngdeuk CHOI ; Woong Kyu HAN ; Jihee JUNG ; Ayoung YOO ; Hyunji YOON ; Siyeong LEE ; Changhwa HYUN ; Woong Sub KOOM ; Ik Jae LEE ; Chan Woo WEE ; Jeongmi LEE ; Jae Young JEONG ; Hyung Ho LEE ; Young Ae KIM ; Jung Eun KIM ; Songhee EUN ; Sung Uk LEE ; Jinha JEONG ; Moonsoo RA
Journal of Urologic Oncology 2025;23(2):112-118
Purpose:
To evaluate patient‐reported experiences of 3 primary treatments for localized or locally advanced prostate cancer—radical prostatectomy (RP), radiation therapy (RT), and active surveillance (AS)—based on cross‐sectional data from a prospective registry, and to explore how these findings can inform a structured shared decision making (SDM) framework.
Materials and Methods:
Men with clinical stage cT3aN0M0 or lower were enrolled. Those who underwent RP or RT were surveyed 6–24 months posttreatment; men on AS had 6–60 months of follow‐up. All participants completed the EORTC QLQ‐PR25 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Prostate Cancer Module), capturing urinary, bowel, hormonal, and sexual function. The Kruskal‐Wallis test evaluated group differences, with significance set at p<0.05.
Results:
Among 542 patients, 435 underwent RP, 73 received RT (43% with androgen deprivation therapy), and 34 were on AS. RP patients reported higher rates of urinary incontinence and sexual dysfunction, whereas RT patients had more severe urinary irritative and bowel symptoms. AS generally preserved baseline sexual function but still involved some urinary complaints and anxiety regarding disease progression. These findings underscore the distinct trade‐offs among the 3 management strategies, emphasizing the importance of individualized SDM that accounts for functional priorities and patient values.
Conclusion
Each treatment modality poses unique impacts on quality of life. Incorporating these patient‐reported data into SDM discussions can improve alignment between clinical recommendations and patient preferences, potentially reducing decisional regret and enhancing long‐term outcomes.
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