Some men diagnosed with prostate cancer may feel there is no time to waste, and will want to quickly decide which treatment option they go for. But could there be some benefit to taking the time to consider more carefully what is the right choice for you?

Certainly, the results of new research suggest that might be the case as it has found at least one in ten men later regret the choice they made. To conduct the research, doctors at Mount Sinai Hospital in Toronto, Canada, enlisted 2,072 men – most of whom were in their sixties – diagnosed with prostate cancer in 2011 and 2012. Nearly half had slow-growing cancers which were unlikely to spread once they had been treated, while the rest had medium-to-high risk cancers with a good chance of spreading.

All the men were treated in one of three ways – they had surgery to remove the prostate, radiotherapy to kill the tumour or active surveillance (sometimes called ‘watchful waiting’ in the UK), where regular checks are carried out every few months to see if the cancer is progressing to the point where more radical treatment is needed.

More than half of the men had immediately opted for surgery to remove the entire prostate, regardless of their initial diagnosis, while most others opted for radiotherapy. Only 13 per cent, mostly those with low-grade cancers, chose active surveillance. At regular intervals over the following five years, the men filled out surveys about how satisfied they were with their initial treatment choice.

Results published in the journal JAMA oncology in November 2021 showed 13 per cent regretted their treatment choice – most of these had opted for swift and radical surgery to remove the prostate. Those with cancers classed as low risk were most likely to wish they hadn’t opted for surgery.

A similar number said they thought they would have been better off with a different treatment approach. In contrast, only 11 per cent regretted choosing radiotherapy and only seven per cent wished they had not opted for active surveillance. However, none of the men with high-risk tumours rued the fact that they opted for more aggressive treatments. 

Most of those wishing they had chosen other therapies said it was to due to the effects of radical treatment on their sexual function; both prostate removal and radiotherapy increase the risk of erectile problems. But some men who opted for active surveillance, only to find their cancers progressed more quickly than they expected, also had regrets, the researchers said.

The findings have led some experts to call for newly-diagnosed patients to take their time in deciding which choice to go for – weighing up the short-term benefits against the potential long-term consequences. 

This was what Dr Mark Garnick, a prostate cancer specialist at Harvard Medical School who did not take part in the research, commented:

‘This study underscores the importance of not rushing into a decision and fully understanding the time course of side-effects… Only when the consequences of treatments or surveillance are fully understood is the patient able to make a truly informed decision.’ 

Dr Garnick said he urges his own prostate cancer patients to speak with disease support groups and other prostate cancer patients about the issues they are likely to face, ‘not necessarily in the immediate future, but years later’.