ASCO GU 2020: Treatment Decision Making in Metastatic Prostate Cancer

San Francisco, California ( Multiple treatment options exist for men with metastatic prostate cancer, and guidelines do not define optimal treatment selection for a given patient. This provides an opportunity for shared decision-making in which physicians communicate treatment purpose, risks, and benefits, and patients communicate personal values/preferences that can be used to determine treatment collectively. Shared decision-making is associated with superior health outcomes (blood pressure, glucose control) in non-cancer populations, but whether it is used in metastatic prostate cancer has not been described.

During the prostate cancer GU ASCO 2020 session, Dr. Alicia Morgans and colleagues presented results of their study assessing metastatic prostate cancer patient and caregiver perceptions of shared decision-making vs physician driven decision or patient driven decision, and treatment decision characteristics for men with metastatic prostate cancer. The conceptual framework for the study is as follows:

This study included patient enrolment between December 14, 2016 and November 17, 2017 for men with metastatic prostate cancer.  Patients and caregivers completed surveys of decision making practices after a clinical encounter in which a decision occurred. To evaluate the relationship between patient perception of decision locus of control type and categorical variables we used Fisher’s exact test, and Kruskal-Wallis was used to evaluate the relationship between decision locus of control and age.

There were 50 patients/caregivers who participated, with a median patient age of 72 years old. Most patients were Caucasian (96%), married (90%), and reported good health or better (18% excellent, 58% good, 24% fair). There were 66% of patients that reported shared-decision making, 10% reported patient directed only, 12% reported physician directed considering patient’s preferences, and 12% reported patient directed considering physician’s recommendation. Caregivers reported numerically lower rates of shared-decision making (56%), physician directed only (6%), and physician directed considering patient’s preferences (8%), but greater patient directed considering physician’s recommendation (30%), (p=0.28). 


Neither group reported patient directed without considering physician recommendations. There was no association between patient decision locus of control and age (p=0.70) or clinician type, (p=0.13). All patients reporting patient directed considering physician’s recommendation saw medical oncologists rather than urologists.

Dr. Morgans concluded with several take-home messages from this important shared-decision-making work among metastatic prostate cancer patients:

  • Both patients and caregivers perceived a majority of decisions as shared-decision making, indicating a high level of patient engagement in metastatic prostate cancer decision making, and clinician type and patient age were not associated with patient reported decision locus of control
  • Patients seen by medical oncology in this cohort reported directing treatment choice when considering physician’s recommendation
  • Efforts to assess and support decision making in more diverse patient populations and explore the association between shared-decision making, patient satisfaction and quality of life are underway.

Presented by: Alicia Morgans, MD, MPH, Medical Oncologist, Northwestern University, Chicago, Illinois

Co-Authors: Angela Fought, Benjamin Lee, David James VanderWeele, Maha H. A. Hussain, Kelvin A. Moses, David F. Penson; Northwestern University, Chicago, IL; University of Colorado Denver, Denver, CO; Northwestern Memorial Hospital, Chicago, IL; University of Chicago Medical Center, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt University, Nashville, TN

Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Twitter: @zklaassen_md at the 2020 Genitourinary Cancers Symposium, ASCO GU #GU20, February 13-15, 2020, San Francisco, California