Background: Considerable controversy surrounds the optimal treatment for localized prostate cancer (LPC). Better understanding of men's treatment decision making process and its influencing factors may help men improve the quality of their treatment decision (e.g. decisional satisfaction, regret, or conflict). The influence of race on these factors is not well understood. We assessed the effects of men's personality, types of physicians seen, and involvement of family and friends on the treatment choice for LPC and the quality of this choice.

Methods: A population-based sample of 154 men (85 white, 69 black) ≤ 75 years with newly diagnosed LPC were mailed a self-administered survey during a pilot study. Patient treatment choice, the reasons for the treatment choice, personality traits, and decisional qualities were assessed using either validated scales or scales developed based on literature review and qualitative research.

Results: Mean age was 61(±7.3) years; 2/3 had >high school education. 59% chose surgery, 31% chose radiation, and 10% chose observation [watchful waiting/active surveillance (WW/AS)]. There were no racial differences in mean age, tumor risk level, number of comorbidities, or treatment choice. Compared to white men, black men were more likely to consult their family about their treatment decision (67% vs. 43%; p=0.01), more likely to have non-private insurance (29% vs. 12%, p=0.01), less likely to be married/partnered (71% vs. 90%, p<0.01), had higher faith (p<0.01), and had lower education (≤high school 43% vs. 25%, p=0.03). In multivariate analysis adjusting for age, race, comorbidity, and tumor risk level, men who saw only urologist(s) were more likely to report the desire to cure the cancer as the major reason for their treatment choice (p=0.01) compared to men who consulted more than urologist(s) (i.e. also saw a radiation oncologist and a primary care physician). Similarly, men who reported consulting a spouse (p<0.01) about their treatment decision were also more likely to report desire to cure the cancer as the major reason for their treatment choice. Men who consulted friends (p<0.01) or had higher education (p=0.02) were more likely to report a desire of avoiding side effects as the major reason for their treatment choice. In addition, men who consulted friends were more likely to choose curative treatment (radiation or surgery) versus observation (WW/AS) [OR=6.9, p<0.01; 6.4, p=0.01, respectively]. Men who reported desire to cure the cancer as a major reason for their decision were more likely to choose surgery compared to radiation or WW/AS [1.5, p=0.01; 1.6, p=0.03, respectively]. Compared to men who saw more than urologist(s) (radiation oncologist and PCP), men who saw urologist(s) only were less likely to choose radiation compared to surgery [0.14, p=0.04]. Furthermore, men who consulted family (3.0, p≤0.01) and friends (3.8, p≤0.01) were more likely to experience higher decisional conflict than men who did not, while these factors were not associated with decisional satisfaction or regret. None of the personality traits (pessimism, optimism, and faith) were associated with decisional qualities.

Conclusions: In addition to types of physicians seen and desire to cure the cancer, consulting family, spouse, and/or friends were significantly associated with men's treatment choice for LPC. Consulting friends during the decision making process increased the odds of men choosing curative treatment (surgery or radiation) compared to observation (WW/AS). Furthermore, consulting friends and/or family also increased men's decisional conflict. These effects did not differ significantly between white and black men.

Citation Format: Elyse Reamer, Felix Yang, Jinping Xu. Treatment decision making in a population-based sample of black and white men with localized prostate cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A48.