Decision Regret in Patients with Localised Prostate Cancer: A Systematic Review and Meta-analysis.

Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to conflict and regret. There is a need to further understand the prevalence and prognostic factors of decision regret to improve patient quality of life.

To generate the best estimates for the prevalence of significant decision regret localised prostate cancer patients, and to investigate prognostic patient, oncological, and treatment factors associated with regret.

We performed a systematic search of MEDLINE, Embase, and PsychINFO databases including studies evaluating the prevalence or patient, treatment, or oncological prognostic factors in localised prostate cancer patients. A pooled prevalence of significant regret was calculated with the formal prognostic factor evaluation conducted per factor identified.

Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17883 patients. This was lower in active surveillance (13%), with little difference between those who underwent radiotherapy (19%) and those who underwent prostatectomy (18%). Evaluation of individual prognostic factors demonstrated higher regret in those with poorer post-treatment bowel, sexual, and urinary function; decreased involvement in the decision-making process; and Black ethnicity. However, evidence remains conflicting, with low or moderate certainty of findings.

A significant proportion of men experience decision regret after a localised prostate cancer diagnosis. Monitoring those with increased functional symptoms and improving patient involvement in the decision-making process through education and decision aids may reduce regret.

We looked at how common regret in treatment decisions is after treatment for early-stage prostate cancer and factors linked with this. We found that one in five regret their decision, with those who had experienced side effects or were less involved in the decision-making process more likely to have regret. By addressing these, clinicians could reduce regret and improve quality of life.

European urology oncology. 2023 Mar 02 [Epub ahead of print]

Jack B Fanshawe, Vinson Wai-Shun Chan, Aqua Asif, Alexander Ng, Mieke Van Hemelrijck, Paul Cathcart, Ben Challacombe, Christian Brown, Rick Popert, Oussama Elhage, Kamran Ahmed, Oliver Brunckhorst, Prokar Dasgupta

Guy's and St Thomas' NHS Trust, London, UK. Electronic address: ., Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK; Division of Surgery and Interventional Sciences, University College London, London, UK., Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Surrey NHS Foundation Trust, Surrey, UK., Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK., Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK., Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK., Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, King's Health Partners, London, UK., MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK; Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Khalifa University, Abu Dhabi, United Arab Emirates., MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK., Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.