Treatment decision-making in men with localized prostate cancer living in remote area: A cross-sectional observational study

Abstract

Introduction: For the management of localized prostate cancer, patient treatment choice is poorly documented among people living in remote areas where access to certain treatments offered in large centres involves travelling several hundred kilometres. This study aimed to describe and identify the determinants of treatment decision-making in men with localized prostate cancer living in remote areas. Methods: In this cross-sectional study, patients with prostate cancer were recruited from Rouyn-Noranda’s urology clinic (Quebec, Canada) between 2017 and 2019. Results: A total of 127 men (mean age 68.34±7.23 years) constituted the study sample. Radiotherapy, a treatment not available locally, was chosen most frequently (67.7%), followed by options available locally, such as surgery (22.8%) and active surveillance (9.4%). Most patients preferred to play an active role in this choice (53.5%) and agreed with the statement, “I chose that treatment because it gives the best chance for a cure” (86.6%). Multiple logistic regression analysis revealed that cancer stage (odds ratio [OR] 10.15; 95% confidence interval [CI] 3.18–32.40) was the only factor associated with radiotherapy choice (patients with lower stage cancer were more likely to choose radiotherapy). The socioeconomic status was not associated with treatment choice. Conclusions: While radiotherapy was not available locally, it was the most frequently chosen treatment, even though the available literature suggests that no one treatment option is superior in terms of cancer control. The choice of radiotherapy is not associated with patient income, but rather the cancer stage. This result could be explained by the patients’ desire to avoid surgery and its adverse effects.