title: Exploring Value From the Patient's Perspective Between Modern Radiation Therapy Modalities for Localized Prostate Cancer.
abstract: Patients' perspectives on their treatment experiences have not been compared between modern radiation modalities for localized prostate cancer. We evaluated treatment regret and patients' perceptions of their treatment experiences to better inform our understanding of a treatment's value.
  
  
  
  Patients with localized prostate cancer treated with stereotactic body radiation therapy (SBRT), intensity modulated radiation therapy (IMRT), or high-dose-rate (HDR) brachytherapy between 2008 and 2014 with at least 1 year of follow-up were surveyed. The questionnaire explored the decision-making experience, expectations of toxicities versus the reality, and treatment regret by means of a validated tool.
  
  
  
  Three hundred twenty-nine consecutive patients were surveyed, with an 86% response rate (IMRT, n=74; SBRT, n=108; HDR, n=94). The median patient age and posttreatment follow-up time were 68 years and 47 months, respectively. Eighty-two percent of patients had T1c disease with either Gleason 6 (42%) or Gleason 7 (58%) pathologic features and a median initial prostate-specific antigen of 5.8 ng/mL. Thirteen percent expressed regret with their treatment. Among patients with regret, 71% now wish they had elected for active surveillance. The incidence of regret was significantly different between treatment modalities: 5% of patients treated with SBRT expressed regret versus 18% with HDR and 19% with IMRT (P<.01). On multivariable logistic regression, patients treated with HDR versus SBRT were 7.42 times more likely to have regret, and patients treated with IMRT versus SBRT were 11.11 times more likely to have regret (P<.01 and P<.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<.01).
  
  
  
  We found significant differences in patients' experiences 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; therefore, pretreatment counseling is essential.
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California. Electronic address: nshaverdian@mednet.ucla.edu.
authors.forename: Narek
authors.initials: N
authors.lastname: Shaverdian
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Darlene
authors.initials: D
authors.lastname: Verruttipong
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Pin-Chieh
authors.initials: PC
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Amar U
authors.initials: AU
authors.lastname: Kishan
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Demanes
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Susan
authors.initials: S
authors.lastname: McCloskey
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kupelian
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steinberg
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000523:psychology*; D003657:Decision Making; D004644:Emotions; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology* / Q000532:radiotherapy*; D016634:Radiosurgery / Q000009:adverse effects / Q000523:psychology*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000523:psychology*; D011795:Surveys and Questionnaires; D057832:Watchful Waiting