title: Decision regret in men undergoing dose-escalated radiation therapy for prostate cancer.
abstract: OBJECTIVE
  Decision regret (DR) is a negative emotion associated with medical treatment decisions, and it is an important patient-centered outcome after therapy for localized prostate cancer. DR has been found to occur in up to 53% of patients treated for localized prostate cancer, and it may vary depending on treatment modality. DR after modern dose-escalated radiation therapy (DE-RT) has not been investigated previously, to our knowledge. Our primary aim was to evaluate DR in a cohort of patients treated with DE-RT.
  
  
  METHODS
  We surveyed 257 consecutive patients with localized prostate cancer who had previously received DE-RT, by means of a validated questionnaire.
  
  
  RESULTS
  There were 220 responses (85.6% response rate). Image-guided intensity modulated radiation therapy was given in 85.0% of patients and 3-dimensional conformal radiation therapy in 15.0%. Doses received included 73.8 Gy (34.5% patients), 74 Gy (53.6%), and 76 Gy (10.9%). Neoadjuvant androgen deprivation (AD) was given in 51.8% of patients and both neoadjuvant and adjuvant AD in 34.5%. The median follow-up time was 23 months (range, 12-67 months). In all, 3.8% of patients expressed DR for their choice of treatment. When asked whether they would choose DE-RT or AD again, only 0.5% probably or definitely would not choose DE-RT again, compared with 8.4% for AD (P<.01).
  
  
  CONCLUSIONS
  Few patients treated with modern DE-RT express DR, with regret appearing to be lower than in previously published reports of patients treated with radical prostatectomy or older radiation therapy techniques. Patients experienced more regret with the AD component of treatment than with the radiation therapy component, with implications for informed consent. Further research should investigate regret associated with individual components of modern therapy, including AD, radiation therapy and surgery.
authors.affiliation: Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour, NSW, Australia.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Steer
authors.forename: Noel J
authors.initials: NJ
authors.lastname: Aherne
authors.forename: Karen
authors.initials: K
authors.lastname: Gorzynska
authors.forename: Matthew
authors.initials: M
authors.lastname: Hoffman
authors.forename: Andrew
authors.initials: A
authors.lastname: Last
authors.forename: Jacques
authors.initials: J
authors.lastname: Hill
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shakespeare
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D003657:Decision Making; D004644:Emotions; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000523:psychology; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000523:psychology* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000523:psychology* / Q000706:statistics & numerical data; D061089:Radiotherapy, Image-Guided / Q000379:methods / Q000523:psychology; D050397:Radiotherapy, Intensity-Modulated / Q000523:psychology / Q000706:statistics & numerical data; D019233:Retreatment / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D000726:Androgen Antagonists