160 - Long-Term Decision Regret among Patients with Localized Prostate Cancer: Results from a Population-Based Cohort

Purpose/Objective(s): Men with prostate cancer face a difficult decision when choosing among management options that differ in their potential effects on urinary, bowel and sexual function. We evaluated whether patients who experience treatment-related symptoms are more likely to have decision regret.

Materials/Methods: The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) enrolled patients across NC with newly diagnosed prostate cancer between 2011-2013. Patients were enrolled prior to treatment and followed prospectively. Decision regret was assessed annually using a validated measure. Bivariate and multivariable regression models were used to assess the association between decision regret through 5-years of follow-up with treatment-related urinary, sexual and bowel symptoms (assessed using the validated Prostate Cancer Symptoms Indices), while adjusting for patient demographic and clinical characteristics.

Results: A total of 1257 participants were included; 23.5% black and 23.4% living in rural areas. Through 5 years of follow-up, 418 (33.3%) reported decision regret. On multivariable analysis, worsened urinary obstruction/irritation compared to baseline (p<.01), and worsened bowel symptoms (p<.01) were associated with increased likelihood of decision regret, and worsened urinary incontinence was of borderline significance (p=.06) (Table). Compared to radical prostatectomy, radiation therapy was associated with a lower likelihood of regret (p=.02) while active surveillance was associated with a greater likelihood (p<0.01) of regret.

Conclusion: Approximately 1 in 3 men with localized prostate cancer have decision regret within 5 years of follow-up. Treatment-related symptoms and treatment choice are significantly associated with regret. These results highlight the importance of informed decision-making for the treatment of localized prostate cancer.