Decisions, decisions. Virtually every action you make, no matter how small, is preceded by a choice or decision. If it doesn’t work out, most have only minor consequences. English muffin or whole wheat toast? Solid tie or striped? Drive or take the commuter train? Coffee or tea? These are small decisions.

The stages of life involve bigger decisions. If you went to college, you chose a major that affected how you earn a living. To marry or not to marry significantly shapes your future. Want to start a family? How many kids can you afford? How about a midlife career change? In these circumstances, you review all the information you’ve gained so far in life. Perhaps you turn to trusted family and friends for their input, or even engage professional consultation services. Ultimately, however, most people rely on their own experience as your inner guide.

Such choices have lifestyle impact and implications, but they are almost never life-or-death. On the other hand, if you are diagnosed with a disease like cancer, the stakes are dramatically higher. Suddenly, decisions become very weighty, and what you’ve learned so far in life may not apply at all to a potentially life-threatening illness. Sure, you can get a lot of information from the internet, but only a professional who gets involved with your personal situation can offer you:

1. Thorough, accurate information about your unique condition,
2. An analysis of your best clinical options,
3. The likely outcomes and side effects of each choice, and
4. Guidance in prioritizing those options to match both your health and your lifestyle.

Today there is new recognition of the need for doctor-patient collaboration in the process of making choices. This is called Shared Decision-Making (SDM). In 2022, the prestigious Journal of the American Medical Association published evidence-based recommendations that were developed by the U.S. Preventive Services Task Force. The article notes:

“Patient-centered care is a core value in US health care. Shared decision-making (SDM), in which patients and clinicians make health decisions together, ensures patients’ rights to be informed and involved in preventive care decisions and that these decisions are patient-centered.”

Prostate cancer treatment regret

The importance of such collaboration really shows up when a man is diagnosed with localized prostate cancer (PCa). Thanks to multiparametric MRI, new biomarkers and genomic tests, and advances in surgery, radiation, and focal ablation treatments, there are more treatment choices than ever, and better ability to match them with each patient’s disease. It’s a balancing act: maximizing cancer control while minimizing side effects. In other words, we doctors want our patients to live as long as possible with the highest quality of life possible. We want our patients to be happy and satisfied that they made the right choice. What we don’t want is our patients to regret the treatment they had.

Here’s the bad news. There is more treatment regret than many doctors realize. A review of over 17,000 cases of patients who received treatment for their localized PCa found that 1 out of 5 patients had significant decision regret.^[i] This is a truly sad situation. We would expect that urinary, sexual and bowel side effects are a big source of regret, but another key cause is lack of sufficient involvement in making the decision. But here’s the good news: it’s avoidable.

When patients are educated about their situation, and included in their decisions all along, they experience having control over their own bodies and having responsibility for what happens to them. They are enabled to form reasonable expectations of things like possible side effects. If doctors are honest with patients, patients are far less likely to feel betrayed or angry if side effects occur, to feel like the doctor sold them a bill of goods, to wish they’d chosen something different.

At the Sperling Prostate Center, we strive to insure that our patients have no cause for regret. Our first step is to share the details of our multiparametric MRI (mpMRI) scan with each patient, explaining in terms they can understand what the imaging reveals. If a biopsy is indicated, we offer an in-bore MRI targeted biopsy that uses a minimum number of needles for the most accurate tissue-based diagnosis.

We then take time to go over all possible treatment choices, describe the process and merits of each as well as possible side effects, and discuss what they value in life and how their treatment choice and recovery will interface with their lifestyle.

There is a saying that you are the captain of your own ship. We want to be on board with you to help you navigate, and we know that the captain always has the final say. For us, Shared Decision-Making is one of our topmost values. Contact us to learn how we can be of help as we collaborate with you every step of the way.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Fanshawe JB, Wai-Shun Chan V, Asif A, Ng A et al. Decision Regret in Patients with Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol. 2023 Mar 2:S2588-9311(23)00037-8.