A randomized trial of choice of treatment in prostate cancer: the effect of intervention on the treatment chosen

OBJECTIVE To determine whether different approaches in the choice of treatment affect the treatment chosen by the patient for prostate cancer. PATIENTS AND METHODS We conducted a randomized trial with 210 men who had a histologically confirmed diagnosis of prostate cancer in 1993–94 at four major hospitals in Finland. After obtaining informed consent the men were randomized either to an intervention arm, in which there was greater patient participation in the choice of treatment following a structured procedure, or a control arm in which the standard approach, i.e. a standardized treatment protocol, was used. The main outcome measure of the analysis was the primary treatment chosen for prostate cancer. RESULTS In the enhanced participation arm patients not eligible for radical prostatectomy chose orchidectomy less frequently and favoured nonsurgical endocrine treatment than in the treatment protocol arm. Radical prostatectomy was the most commonly chosen treatment option in both arms among men with operable cancer. The way treatment options were presented affected the treatment chosen for prostate cancer. CONCLUSION Patients with prostate cancer are willing and able to take an active role in making decisions. The preferences of patients with prostate cancer in the choice of treatment may differ from the priorities of the physicians.