There are many treatment options for men who are newly diagnosed with prostate cancer. There are a lot of considerations, and all men (and their families) want to make the “right choice.” It is a doctor’s role to help guide their patients through shared decision-making to find the treatment choice that is best for them.

Most men newly diagnosed with prostate cancer will need to decide between a variety of treatment options. These choices include active surveillance, radical prostatectomy (surgery), and radiation therapy (either external beam or brachytherapy). Cancer control, short- and long-term side effects, and the burden and costs of treatment will be important to think about in the decision-making process. Ultimately, the goal is to allow each man to find the treatment choice that feels right to him, given his goals and priorities. However, some men will eventually regret their choice. A better understanding of how and why some men regret their choice will hopefully mean fewer men experience regret in the future.

Recent research on treatment regret has shown that it is most common in men where the outcomes they experience three and five years after treatment were “a lot worse” than they expected before deciding on treatment. This may be either because the treatment was less effective than expected (i.e., the cancer control was not as expected), or because the treatment had worse side effects than expected.

This research highlights an opportunity to reduce treatment-related regret. Getting more than one opinion and making sure you have all of your questions answered before making a treatment choice is an important action you can take to reduce your chances of regret in the future.

In the leading study that looks at treatment-related regret, patients who chose active surveillance were less likely to experience treatment-related regret than those who chose active treatment with surgery or radiotherapy. This means that for men who are eligible, active surveillance is a treatment approach with a proven lower rate of long-term regret (even though the side effects of this treatment may include urinary incontinence, sexual dysfunction, and bowel issues). Plus, men with serious changes in sexual function were more likely to have regret.

Other research has shown that a “discussion of all treatment options” may reduce treatment-related regret. This means it’s important to talk with several different kinds of doctors including urologists and radiation oncologists before making a decision.

In the end, everyone involved in your prostate cancer journey — you as the patient, your family, and your doctors — are hoping that you can find the right treatment for you. Your family and healthcare team also want to help you on that journey. Fully exploring all treatment options and understanding both the cancer control and side effects of each choice is critical to help prevent treatment regret.

Zachary Klaassen, MD, MSc
Urologic Oncologist, Georgia Cancer Center, Augusta University, Augusta, GA, USA