3387 - What Matters Most to Patients with Localized Prostate Cancer: Prospective Preference Data from a Statewide Consortium
Presenter(s)
J. D. Tang1, H. Yin1, M. Zaki2, M. Mislmani3, D. Kendrick4, M. Mietzel1, P. McLaughlin5, V. Narayana5, S. R. Miller II6, K. Hopfensperger1, D. K. Heimburger7, W. C. Jackson1, M. Schipper8, and R. T. Dess1; 1Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Covenant HealthCare, Saginaw, MI, 3West Michigan Cancer Center, Kalamazoo, MI, 4Michigan Radiation Oncology Quality Consortium Coordinating Center, Ann Arbor, MI, 5Henry Ford Health, Novi, MI, 6Wayne State University, Detroit, MI, 7Munson Healthcare, Traverse City, MI, 8University of Michigan, Ann Arbor, MI
Purpose/Objective(s): Management of localized prostate cancer requires selecting among guideline-concordant options with different efficacy, toxicity and burden profiles. As radiation and androgen deprivation therapy (ADT) options expand, patient preferences increasingly guide treatment selection. We analyzed preference factors collected prospectively from a statewide quality consortium to quantify patient priorities informing these decisions.
Materials/Methods: Patients with intact localized prostate cancer treated with definitive radiation (+/- ADT) from 10/2020–1/2026 were enrolled across 26 facilities (n=2147). At baseline, participants rated the importance (0–10) of ten treatment decision factors. These included Global Priorities (Cure, Quality of Life [QOL]), Treatment Burden (Cost, Convenience, Invasiveness), and Function (Urinary Leakage, Urinary Frequency, Rectal Problems, Erectile Function, Hormonal Therapy). Ratings were categorized as Low (0–3), Moderate (4–7), or High (8–10). Chi-squared analyses assessed associations between baseline characteristics and factor prioritization.
Results: Median age was 71; most had NCCN intermediate (65%) or high-risk (31%) disease, and 62% received ADT. Cure and QOL were each rated Highly Important by 92% and 91% of patients, respectively. However, Cure was more often a distinct "10/10" priority than QOL (79% vs 69%, p<0.001). Treatment Burden factors, Cost (26%), Convenience (56%), and Invasiveness (67%), were less frequently rated Highly Important (p<0.001 vs Cure/QOL). However, avoiding Treatment Burden was significantly more important among Black patients and those with lower income or education (p<0.001 across all three domains).
Although Global QOL was highly prioritized, subdomain preferences varied. Patients more often highly prioritized avoiding rectal problems (77%) and urinary leakage (71%) more than avoiding urinary frequency (58%), preserving erectile function (50%), or hormone therapy effects (48%, p<0.001 for all). Baseline function influenced these priorities: patients with moderate/high baseline urinary symptoms were more likely to prioritize avoiding urinary frequency (73% vs 55%, p<0.001), and patients with baseline sexual function were more likely to prioritize preserving erectile function (70% vs 45%, p<0.001) and avoiding hormone therapy (55% vs 46%, p<0.001).Conclusion: Patients with localized prostate cancer place high importance on both cure and overall QOL, but priorities for treatment burden and functional trade-offs vary. Preservation of bowel and urinary continence is prioritized over sexual function or convenience, and preferences are strongly associated with baseline function and socioeconomic factors. Future work will evaluate associations among these preferences, tumor factors, and treatment received.