Clinical Scorecard: Regret in Treatment Decisions Following External Beam Radiotherapy with High Dose-Rate Brachytherapy for Prostate Cancer
At a Glance
Category
Detail
Condition
Localized prostate cancer
Key Mechanisms
External beam radiotherapy combined with high dose-rate brachytherapy boost for dose escalation
Target Population
Men with histologically confirmed localized prostate cancer treated with EBRT + HDR-BT boost
Care Setting
Academic tertiary cancer center, outpatient survivorship care
Key Highlights
Decision regret is a common negative cognitive-emotional outcome after cancer treatment decisions, measured by the Decision Regret Scale (DRS).
Approximately 57% of cancer patients report some degree of decision regret after radiotherapy, with mean DRS scores around 14-17.
Determinants of decision regret include health-related quality of life, shared decision-making, balance of expected vs. experienced outcomes, and radiation dose parameters.
Guideline-Based Recommendations
Diagnosis
Confirm prostate cancer histologically before treatment.
Assess disease status post-treatment using Phoenix criteria (PSA > 2 ng/ml above nadir indicates recurrence).
Management
Use EBRT combined with HDR-BT boost as a dose escalation strategy for localized prostate cancer.
Deliver EBRT in 2 Gy fractions up to 40–50 Gy over 20–25 fractions, with two HDR-BT fractions of 8 Gy to the whole prostate and 15 Gy to the peripheral zone.
Monitoring & Follow-up
Evaluate patient-reported outcomes including decision regret (DRS), prostate cancer-specific HRQoL (EPIC-26), generic cancer HRQoL (EORTC QLQ-C30), and patient satisfaction (PSCC).
Monitor dose exposure to organs at risk (urethra, bladder neck, rectum) to understand potential impact on regret and outcomes.
Risks
Decision regret may negatively impact survivorship quality of life.
Higher radiation doses to organs at risk may influence regret and functional outcomes.
Patient & Prescribing Data
Men treated with EBRT combined with HDR-BT boost for localized prostate cancer at least two years prior, disease-free per Phoenix criteria.
Patients report varying levels of decision regret post-treatment; shared decision-making and quality of life domains influence regret levels.
Clinical Best Practices
Incorporate shared decision-making to reduce decision regret and improve patient satisfaction.
Use validated patient-reported outcome measures (DRS, EPIC-26, EORTC QLQ-C30, PSCC) to monitor treatment impact and regret.
Carefully plan radiation dose to minimize exposure to organs at risk to potentially reduce regret and adverse effects.
Provide survivorship support addressing emotional and physical functioning to mitigate decision regret.
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
Recent research at Roswell Park Comprehensive Cancer Center led by Anurag Singh, MD, Director of Radiation Research, has shown that for patients with peripherally located lung cancer, one treatment of stereotactic body radiation therapy (SBRT) is equally effective as longer courses radiation therapy.
