The choice between a therapy-induced long-term symptom and shortened survival due to prostate cancer.
OBJECTIVE
A patient with newly diagnosed localized prostate cancer can choose from an array of therapies. A patient's willingness to trade life for freedom from therapy-induced long-term symptoms is poorly investigated.


METHODS
In October 2002, we attempted to collect information from the 591 men who had been diagnosed and registered with prostate cancer in 1999 in Stockholm County. In a postal questionnaire, men were asked to balance absence or presence of certain therapy-induced long-term symptoms against varying lengths of survival gain as a consequence of the therapy.


RESULTS
Information was provided by 511 (86%) of the 591 men. A large majority of the men participating in this study ended up in one of two extreme categories: either they accepted the therapy-induced symptom to gain survival or they did not. For fecal leakage, 78% of the men chose one of two extreme categories compared with 74% for urinary leakage, 71% for tender enlarged breasts, 73% for erectile dysfunction, and 78% for restricted diet. Thirty-seven percent of the men in the study were willing to accept fecal leakage if there was only the slightest chance to gain survival, comparing percentages for urinary leakage, tender enlarged breasts, restricted diet, and erectile dysfunction and were 48%, 53%, 55%, and 64%, respectively.


CONCLUSIONS
Willingness to accept therapy-induced long-term symptoms to avoid a shortened survival due to prostate cancer varies dramatically among men with localized prostate cancer and a large majority of men are in one of two extreme categories. Among symptoms, long-term fecal leakage was the one fewest men were willing to accept to gain survival.
Hopfgarten
Thomas
T
Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden.
Adolfsson
Jan
J
Henningsohn
Lars
L
Onelöv
Erik
E
Steineck
Gunnar
G
D000368:Aged; D016009:Chi-Square Distribution; D002755:Choice Behavior; D006801:Humans; D008017:Life Expectancy; D008297:Male; D010342:Patient Acceptance of Health Care; D011183:Postoperative Complications / Q000523:psychology; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D012042:Registries; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology