Patient Knowledge and Qualities of Treatment Decisions for Localized Prostate Cancer

Lisa M. Daum; Elyse N. Reamer; Julie J. Ruterbusch; Joe Liu; Margaret Holmes-Rovner; Jinping Xu

doi:10.3122/jabfm.2017.03.160298

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Figure 1.
Information sources used when seeking knowledge of prostate cancer. Mags/Bks, magazines/books; PCP, primary care physician; Rad Onc, radiation oncologist.

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Table 1.

Response to Knowledge Statement by Race and Treatment (N = 192)

Knowledge Statement^*	Overall (n = 192)	Race			Treatment
Knowledge Statement^*	Overall (n = 192)	White (n = 102)	Black (n = 90)	P Value	AS/WW (n = 16)	Radiation (n = 53)	Surgery (n = 96)	P Value
There are several ways to treat early stage prostate cancer successfully. (True)	89.6	92.2	86.7	.18	93.8	92.5	89.6	.71
If men live long enough, most will have cancer cells in their prostate, but few will die of prostate cancer. (True)	69.3	78.4	58.9	.01	87.5	77.4	63.5	.06
Treatment for prostate cancer can have serious long-term side effects. (True)	64.6	72.5	55.6	.03	62.5	54.7	70.8	.20
In the early stage, doctors can't always tell how your prostate cancer will act. (True)	62.5	67.6	56.0	.22	81.3	54.7	67.7	.19
Most prostate cancers grow very slowly and rarely cause problems. A few grow quickly. (True)	58.9	67.6	48.9	.02	56.3	54.7	63.5	.54
Having surgery on a cancer increases the possibility that the cancer will spread to other parts of the body. (False)	50.5	59.8	40.0	.01	37.5	35.8	65.6	<.01
Surgery leads to more urinary incontinence side effects (leaking urine) than radiation. (True)	47.9	44.1	52.2	.19	31.3	52.8	52.1	.24
Surgery leads to more sexual side effects (inability to have erections) than radiation. (True)	44.3	46.1	42.2	.88	43.8	47.2	44.8	.87
Having radiation as the first treatment can make it difficult for doctors to perform surgery if the cancer came back later. (True)	41.1	54.9	25.6	<.01	25.0	34.0	53.1	.02
Radiation leads to more bowel problems (leaking stool or rectal bleeding) than surgery. (True)	37.5	42.2	32.2	.23	25.0	34.0	41.7	.38
The chance of being alive 10 years after treatment is the same for surgery as it is for radiation. (True)	35.4	45.1	24.4	<.01	31.3	52.8	29.2	.01

Data are the percentages of correct responses, unless otherwise indicated. Bold values in table indicate the difference was “statistically significant”.
↵* True and false answers are based on our knowledge scale.
AS, active surveillance; WW, watchful waiting.

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Table 2.

Characteristics of Study Sample (N = 201)

	Patients
Age, years
<65	123 (61)
≥65	78 (39)
Race
Black	97 (48)
White	104 (52)
Married/partnered
Yes	151 (77)
No	46 (23)
Education
<High school	18 (9)
High school graduate/some college	113 (57)
College graduate or more	68 (34)
Gleason score
≤6	97 (49)
7	78 (39)
≥8	24 (12)
Prostate-specific antigen (ng/mL)
≤4	77 (39)
4.1-<10	87 (45)
10-<15	13 (7)
≥15	18 (9)
Insurance
Private	154 (78)
Nonprivate	43 (22)
Treatment
Active surveillance	17 (9)
Surgery	99 (54)
Radiation	53 (29)
Other	16 (9)
Knowledge, mean (SD)	5.87 (2.5)
Information sources, mean (SD)	3.94 (2.5)

Data are n (%) unless otherwise indicated. Some of the numbers may not add to the total (N = 201) because of missing values.
SD, standard deviation.

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Table 3.

Effect of Unadjusted Variables on Prostate Cancer Knowledge Score

Variable	Unadjusted Estimate	95% CI	P Value^*
Age	−0.49	−1.19 to 0.22	.17
Race (reference: white)	−1.47	−2.13 to −0.82	<.001
Married/partnered	1.93	1.16–2.70	<.001
Education	1.39	0.85–1.92	<.001
Gleason score	−0.38	−0.89 to 0.13	.14
PSA level	−0.38	−0.75 to −0.01	.046
Insurance (reference: private)	−2.29	−3.04 to −1.53	<.001
Treatment (reference: surgery)			.06
AS/WW	−0.73	−1.98 to 0.52	.25
Radiation	−0.61	−1.41 to 0.18	.13
Other	−1.61	−2.90 to −0.32	.01
Information sources, n	0.27	0.13–0.40	<.001

Bold values in table indicate the difference was “statistically significant”.
↵* Linear regression analysis.
AS, active surveillance; CI, confidence interval; PSA, prostate-specific antigen; WW, watchful waiting.

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Table 4.

Effect of Adjusted Variables on Prostate Cancer Knowledge Score^*

Variable	Adjusted Estimate^*	95% CI	P Value^{^†}
Age	−0.32	−0.98 to 0.34	.34
Race (reference: white)	−0.75	−1.42 to −0.08	.03
Married/partnered	1.44	0.61–2.27	<.001
Education	0.94	0.40–1.48	<.001
PSA Level	−0.16	−0.51 to 0.19	.37
Treatment (reference: surgery)			.42
AS/WW	−0.48	−1.63 to 0.68	.41
Radiation	−0.45	−1.17 to 0.28	.23
Other	−0.70	−1.91 to 0.52	.26
Information sources, n	0.20	0.07–0.34	.003

Bold values in table indicate the difference was “statistically significant”.
↵* Adjusted for race, marriage, education, age, prostate-specific antigen (PSA) level, and treatment choice.
↵† Linear regression analysis.
AS, active surveillance; CI, confidence interval; WW, watchful waiting.

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Table 5.

Effect of Prostate Cancer Knowledge Score on Decision-Making Difficulty, Satisfaction, and Regret

Decisional Measure	Unadjusted OR (95% CI)	P Value^{^†}	Adjusted OR^* (95% CI)	P Value^{^†}
Satisfaction	0.88 (0.78–1.00)	.06	0.88 (0.75–1.03)	.12
Regret	1.02 (0.91–1.15)	.72	1.10 (0.94–1.27)	.24
Difficulty	1.14 (1.01–1.29)	.04	1.26 (1.07–1.49)	.007

Bold values in table indicate the difference was “statistically significant”.
↵* Adjusted for race, marriage, education, age, prostate-specific antigen level, and treatment choice
↵† Logistic regression analysis.
CI, confidence interval; OR, odds ratio.