Regret in Treatment Decisions After EBRT with HDR-Brachytherapy for Prostate Cancer
Overview
This study assessed decision regret in prostate cancer patients treated with external beam radiotherapy combined with high dose-rate brachytherapy (EBRT + HDR-BT). Approximately 14% of patients reported strong decision regret, which was associated with worse urinary and sexual quality of life, lower shared decision-making, and higher doses to organs at risk.
Background
Localized prostate cancer is the most common cancer diagnosis among men in Western countries, with multiple treatment options including surgery, EBRT, brachytherapy, or combinations thereof. EBRT combined with HDR-BT boost is a well-established radiotherapy dose escalation method offering favorable long-term prognosis. Given the extended survivorship, understanding patient decision regret after treatment is critical to improving quality of life and shared decision-making.
Data Highlights
Decision Regret Category
Percentage of Patients
No decision regret (0 points)
54%
Mild decision regret (1–25 points)
32%
Strong decision regret (>25 points)
14%
Key Findings
14% of patients reported strong decision regret after EBRT + HDR-BT for prostate cancer.
Higher decision regret scores correlated with worse urinary incontinence, urinary irritative/obstructive symptoms, and sexual function as measured by EPIC-26.
Lower levels of shared decision-making, assessed by patient satisfaction with inclusion in health decisions, were associated with increased regret.
Higher radiation doses to organs at risk, particularly the urethra and bladder neck, were linked to greater decision regret.
Decision regret was not significantly associated with patient age, comorbidity, or time since treatment.
Clinical Implications
Clinicians should prioritize shared decision-making and thoroughly discuss potential urinary and sexual side effects when counseling patients considering EBRT combined with HDR-BT. Monitoring and minimizing radiation dose to organs at risk may reduce long-term regret and improve quality of life. Incorporating patient-reported outcomes into follow-up can help identify individuals at risk for decision regret.
Conclusion
Decision regret after EBRT combined with HDR-BT for prostate cancer affects a meaningful minority of patients and is influenced by treatment side effects, shared decision-making, and radiation dose to critical structures. Addressing these factors may enhance patient satisfaction and survivorship outcomes.
References
Rühle et al. 2021 -- Decision Regret After Radiotherapy in Cancer Patients
Chehade et al. 2020 -- Concept Analysis of Decision Regret in Healthcare
by Lars Haack, David Krug, Severin Rodler, Philipp Nuhn, Christof van der Horst, Christian Schulz, Olaf Wittenstein, Claudia Schmalz, Oliver Blanck, Frank-André Siebert, Alexander Fabian
