How many times in your life have you made a big decision…and afterwards realized it was a BIG mistake? Hopefully, never. Life’s biggest decisions generally concern longtime commitments. They fall into categories such as marriage, parenting, career, where to live, and planning for retirement. Mistakes can lead to years of regret. Your happiness—and that of others who love you—is on the line.

Another area for potential regret is healthcare. Our wellness impacts our self-image, happiness, and longevity. In fact, longevity comes first. A cancer diagnosis naturally triggers immediate concern: is this going to kill me? Thoughts of self-image and happiness take a back seat to the instinct for life, so lifesaving is the main driver for choice of treatment.

On the other hand, these days the majority of prostate cancer (PCa) cases are diagnosed as Stage 1 when it is not highly aggressive and still contained in the prostate gland. This means that all treatment choices will have the same result. Statistically, 100% of PCa patients treated for Stage 1 PCa are still alive at five years—and most will go on to live out their full days.

With this assurance, the consideration of dying from PCa diminishes. Instead, the potential for regretting one’s treatment decision stems from a threat to self-image and happiness. PCa treatments come with risks of side effects that hurt a man’s quality of life: incontinence and sexual dysfunction.

Did you know there are two types of decision regret? This point was made by Dr. Sarah Psutka, Associate Professor of Urology at the U of Washington and Fred Hutchinson Cancer Center, who gave a presentation on the topic at the Dec. 2024 Society of Urologic Oncology (SUO) annual meeting. She identified:

• Anticipatory regret – thinking in advance about what might lead to regret after treatment
• Retrospective regret – the treatment is complete but the patient feels he made a mistake.

Dr. Psutka noted that PCa patients with localized disease face quite a menu of disease management choices, from whole-gland treatment like robotic prostatectomy, whole gland ablation, and various methods of radiation with or without hormone treatment, to less aggressive focal ablation, to least aggressive Active Surveillance. None of these choices is completely regret-free. About 1 in 7 PCa patients with localized disease will have some measure of regret.

She cited the following regret ranges:

• Prostatectomy 12-57%
• Radiation therapy 1-49%
• Hormone therapy (androgen deprivation) 28-49%
• Combination surgery or radiation + hormone therapy 21-47%
• Active surveillance 7-43%

Avoiding decision regret

Is there a way to prevent regret? Dr. Psutka suggested a combination of elements, each of which requires a level of physician involvement and understanding that not all doctors may be able to provide.

First, doctors should provide information. Not only does this mean explaining each treatment choice and the risk of side effects, but more broadly equipping patients with knowledge to improve their health in general. Busy doctors rarely have the luxury of relaxed time with their PCa patients, but there are decision aids (patient materials that have at-a-glance comparison charts or other graphics) that patients can review at home. An important part of patient education is assuring patients that should side effects occur there are ways to minimize their impact on the patient’s quality of life, and describe them.

Second, embrace shared decision-making. While the doctor is trained and experienced in clinical services and can offer informed advice, it is the patient who will live with the outcomes of treatment. It is a team dialogue for each to responsibly participate in pondering the pros and cons of options. The doctor must respect the patient’s autonomy, and the patient must trust the doctor’s professional knowledge.

Third, the doctor should explore the patient’s values and feelings, and help the patient forecast how he might feel about the realities and aftermath of each treatment. Treatment decisions are not purely rational; patients have fears and worries, and if they are in a relationship their partner’s feelings will also be impacted by the aftermath of treatment. The doctor should help the patient explore his inner world.

Studies have shown that patients who perceive that their doctor includes and cares about them, who feel heard and understood by their physician, are more likely to accept and deal reasonably with unpleasant post-treatment surprises. Advances in less invasive treatment methods can help lower the rate and duration of side effects like incontinence and erectile dysfunction. Just as importantly as minimizing side effects, the growing emphasis on shared decision-making and improved physician sensitivity training can help avert decision regret when the unexpected occurs.

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.