Prostate cancer patients overwhelmingly chose active surveillance over aggressive therapy when they used a new program to help them make a decision about treatment.

The online interactive program, developed by researchers at Thomas Jefferson University in Philadelphia, is intended to help patients clarify their treatment options and preferences, as well as better inform discussions with clinicians about their options. It's also bringing more attention to shared-decision making, which is becoming an important tool for providers who want to improve the quality of care they bring to their patients.

While patients can use the program to make an informed decision for any disease, the team tested the program on 23 low-risk prostate cancer patients. After interacting with the program, 83 percent of the study cohort decided on active surveillance rather than aggressive treatment. This is contrary to the norm where the vast majority of men diagnosed with low-risk cancer undergo aggressive treatment (radiation therapy or surgery) rather than active surveillance (PSA test or biopsy).
"That's a huge difference obviously, and it makes a difference in terms of the side effects of aggressive treatment," Dr. Ronald Myers of Thomas Jefferson University and principle investigator of the project told DOTmed News.

Some side effects associated with aggressive treatment include urinary incontinence and sexual dysfunction.

According to Myers, only about 20 percent of men nationally initiate active surveillance over aggressive treatment. However, recent clinical evidence finds that the mortality rate for early stage prostate cancer is the same for men who choose active surveillance versus those who decide to treat it aggressively.

Although it's an online tool, like many shared decision-making tools, the nature of the program is rather personal. Typically, a nurse will meet with the patient to make sure they understand the basic issue and treatment options available. The nurse will then take the patient through a series of online questions that result in a computer-generated preference score and a one-page summary report that helps patients visualize their inclination toward active surveillance or aggressive treatment. Finally, a copy of the report is given to the patient and clinician so that they can meet and discuss the decision.

"It makes a difference in terms of outcomes and the costs, and in this context, it also makes a big difference because patients and their clinicians are making a well-informed shared decision, so it seems like this is an important way to go," said Myers.

The research is being presented this week at the Society for Medical Decision Making annual meeting in Baltimore, Maryland.

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