Presentation Authors: Sunny Nalavenkata*, Allan Smith, Orlando Rincones, Mark Sidhom, Pascal Mancuso, Karen Wong, Megan Berry, Dion Forstner, Leslie Bokey, Afaf Girgis, Sydney, Australia
Introduction: To understand the decision making process in men diagnosed with localised prostate cancer (LPC) who are attending a combined clinic (CC), deciding between robotic prostatectomy and radiotherapy.
Methods: Men diagnosed with clinically significant LPC who were suitable for either robotic assisted radical prostatectomy (RP) or radiotherapy (RT) were eligible for recruitment. Participants attended a CC at a tertiary referral centre (Liverpool Hospital, Sydney), where they consulted a urologist and radiation oncologist regarding treatment options._x000D_
A mixed-methods design was used. Initial treatment preferences and final treatment choices were collected via questionnaires. Consultations at the CC were audio-recorded and transcribed verbatim. Consultations were analysed in NVivo using a study-specific coding framework. A sub-set of participants (n = 25) completed semi-structured interviews outlining their beliefs, values and decision-making process. Interviews were thematically analysed.
Results: Fourty-one patients who were approached (89%) consented to participate in this study (n=2 declined; n=3 non-responders). Patient mean age was 66 years old. Mean pre-op PSA was 9.1. The most prevalent grade was ISUP grade II (47%) followed by ISUP III (19%)._x000D_
Twenty-eight (68%) participants ultimately chose robotic prostatectomy (RP), 12 (29%) chose radiotherapy (RT), and 1 (2%) deferred treatment. Initial treatment preference was recorded in 36 patients. 17 out of 21 (81%) patients with an initial preference ultimately retained their original choice, whilst 4 (19%) patients changing their preference from RP to RT. In the 13 patients who were unsure about treatment before the CC, 8 (62%) subsequently chose RALP, and 5 (38%) chose RT. _x000D_
Interviews revealed that treatment choice is largely dependent on cliniciansâ€™ recommendations and participants did not routinely compare specific side effects of each treatment. In patients who were undecided or changed preference, factors which played a significant role in decision-making included treatment delivery, side effects, age and comorbidities (71% of patients). There was a strong patient belief that robotic prostatectomy provided a more definitive cure (74% of RP patients), whilst older men preferred radiotherapy as it had a perceived lesser impact on lifestyle (66% of RT patients).
Conclusions: Men who already had an initial treatment preference were unlikely to change their ultimate decision following the combined clinic consultation. In undecided patients, tailored discussion focusing on patient and treatment factors contributed to their treatment choice. Early involvement in a combined clinic can benefit the undecided patient in making a balanced and informed decision.