Decision regret in men undergoing dose-escalated radiation therapy for prostate cancer.

PURPOSE: Decision regret (DR) is a negative emotion associated with medical treatment decisions, and it is an important patient-centered outcome after therapy for localized prostate cancer. DR has been found to occur in up to 53% of patients treated for localized prostate cancer, and it may vary depending on treatment modality. DR after modern dose-escalated radiation therapy (DE-RT) has not been investigated previously, to our knowledge. Our primary aim was to evaluate DR in a cohort of patients treated with DE-RT. METHODS AND MATERIALS: We surveyed 257 consecutive patients with localized prostate cancer who had previously received DE-RT, by means of a validated questionnaire. RESULTS: There were 220 responses (85.6% response rate). Image-guided intensity modulated radiation therapy was given in 85.0% of patients and 3-dimensional conformal radiation therapy in 15.0%. Doses received included 73.8 Gy (34.5% patients), 74 Gy (53.6%), and 76 Gy (10.9%). Neoadjuvant androgen deprivation (AD) was given in 51.8% of patients and both neoadjuvant and adjuvant AD in 34.5%. The median follow-up time was 23 months (range, 12-67 months). In all, 3.8% of patients expressed DR for their choice of treatment. When asked whether they would choose DE-RT or AD again, only 0.5% probably or definitely would not choose DE-RT again, compared with 8.4% for AD (P<.01). CONCLUSION: Few patients treated with modern DE-RT express DR, with regret appearing to be lower than in previously published reports of patients treated with radical prostatectomy or older radiation therapy techniques. Patients experienced more regret with the AD component of treatment than with the radiation therapy component, with implications for informed consent. Further research should investigate regret associated with individual components of modern therapy, including AD, radiation therapy and surgery.

Steroidal antiandrogen administration to treat gonadotropin-releasing hormone analogue-induced orchialgia.

OBJECTIVE: To describe a case of gonadotropin-releasing hormone (GnRH) analogue-induced orchialgia and to outline a novel treatment for this debilitating adverse effect. METHODS: In this case report, we describe the clinical, laboratory, and imaging findings of the study patient and describe the treatment approach. RESULTS: After 15 months of treatment with a GnRH analogue (goserelin acetate), a 76-year-old man with prostate cancer that had been treated with standard therapy presented with bilateral testicular pain that was refractory to simple analgesics. It was not possible to discern an etiology for the orchialgia from his history, and he had received no new prescription medications. On physical examination, he had no evidence of skin rash, inflammation, or abnormalities of the testes, although there was marked tenderness on palpation. Findings from testicular ultrasonography were unremarkable and confirmed normal anatomy and blood flow. His prostate-specific antigen nadir was satisfactory at 0.1 ng/mL, indicating a strong, persistent biochemical response to combined hormonal blockade and radiation therapy. The use of a steroidal antiandrogen (cyproterone acetate) effectively abated the reported testicular pain. CONCLUSIONS: The use of GnRH analogues in the endocrine management of prostate cancer is becoming more widespread, and clinicians should be aware of orchialgia as a rare adverse effect. This is the first reported case of testicular pain in association with goserelin acetate, and we conclude that cyproterone acetate may have a useful role in managing this condition.