Comedians sometimes become identified by a catchphrase, like Rodney Dangerfield’s “No respect.” According to him, it’s the story of his life—and it became the unforgettable story of his stand-up routines.

Just as Dangerfield was tagged with those two words, the late Joan Rivers will be remembered for her 3- word question “Can we talk?” According to The Hollywood Reporter, she explained, “I always try to be very honest — my humor is truly stripping everything. Bam!” In other words, “Let’s stop this nonsense!”

Well, prostate cancer (PCa) is no laughing matter—though some might find dark humor aggressive whole gland treatments. I’m thinking of oncologist Mark Scholz’s book titled Invasion of the Prostate Snatchers. While the title is provocative and tongue-in-cheek word play on the 1956 horror film about body snatchers, his point is that radical treatments like prostatectomy and radiation are overkill for the majority of PCa patients who are diagnosed with early stage, low risk disease.

In fact, studies report anywhere from 10-25% of men who had prostatectomy for their localized PCa regret their decision, even as far out as 16 years later, according to a new paper by Lunger, et al. (2023).^[i] Their study included 3408 patients who had surgery as a primary treatment and were followed for at least 15 years. Those who reported decision regret were more likely to also have depression, anxiety, and low health-related quality of life.

Interestingly, how the patients made the decision seems to have influenced whether or not they would have regret. Choosing a treatment is not a simple task. As the authors write,

Patients with localized prostate cancer are faced with a variety of therapeutic options, ranging from active surveillance to radical prostatectomy, external beam radiation or focal therapies. Selecting the most suitable treatment can be difficult and requires the treating physician to spend adequate time and effort to involve patients during the decision-making process.^[ii]

As part of their research, the authors found that patients who experienced shared decision-making in discussion with their doctor were much less likely to regret their surgery than were those who described their decision-making as passive or active on their own.

Based on their findings, the authors offer a simple recipe for avoiding decision regret: “Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret.”^[iii] In other words, doctors should create a “let’s talk about all options” atmosphere when they deliver the diagnosis—and the options should include focal therapies, Active Surveillance, and what qualifies a patient for less invasive strategies. Notice that the two main ingredients are a) patient education and b) working together toward a decision best-suited for the patient’s clinical needs and lifestyle preferences.

Or, if the doctor doesn’t appear to offer anything beyond surgery or radiation, perhaps it’s up to the patient to look him/her in the eye and ask, “Can we talk?”

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] Lunger L, Meissner VH, Kopp BCG, Dinkel A et al. Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy. BMC Urol. 2023 Aug 23;23(1):139.
[ii] Ibid.
[iii] Ibid.