Prostate surgery is a common treatment for prostate cancer. Patients considering this procedure often wonder about their long-term satisfaction and potential emotional outcomes, including what is commonly referred to as “regret.” This article explores the meaning of regret in this medical context and its reported prevalence.
Defining Regret After Prostate Surgery
Regret after prostate surgery is a complex, subjective patient experience that extends beyond simple dissatisfaction. It signifies a negative emotional state, involving distress or remorse, arising from a decision when the actual outcome is compared to a perceived better alternative that was not chosen. This sentiment stems from unmet expectations, unforeseen side effects, or a perceived decline in quality of life following the procedure. Patients may feel they would have been better off with a different treatment or wish they could change their mind.
Patient satisfaction and quality of life are routinely measured using patient-reported outcomes (PROs) and surveys. While objective outcomes like improved cancer control are important, a patient’s subjective experience with new side effects can still lead to feelings of regret.
How Common is Regret?
Reported rates of regret after prostate surgery vary depending on study methodology, follow-up duration, and how regret is defined. Overall, treatment-related regret among patients with localized prostate cancer has been reported to range from 2% to 18%.
Rates of regret for radical prostatectomy tend to be higher compared to other treatment options like active surveillance or radiotherapy. One study found that at five years post-diagnosis, 16% of patients who underwent surgery experienced treatment-related regret, compared to 11% for radiotherapy and 7% for active surveillance. Another long-term study observed that 15% of those who received surgery expressed regret after 15 years. While a German study found overall low rates of regret for prostate cancer surgery, it noted that patients with complications like incontinence or impotence were more likely to express regret. Some research suggests that regret may even increase with longer follow-up periods.
Key Factors Influencing Regret
Several factors contribute to feelings of regret after prostate surgery, primarily stemming from the impact of post-operative side effects on a patient’s quality of life. The most commonly identified factors are treatment toxicity, particularly issues related to sexual and urinary function. Erectile dysfunction and urinary incontinence are frequently cited as significant sources of bother, impacting daily life and potentially leading to regret. Some patients also experience bowel dysfunction, which can contribute to regret.
Beyond physical side effects, a disconnect between patient expectations and actual treatment outcomes is a significant driver of regret. Patients who perceive their treatment as less effective or their adverse events as more severe than anticipated are more likely to experience regret. Inadequate pre-operative counseling and a lack of comprehensive information about potential outcomes or alternative treatments can lead to unrealistic expectations. If patients are not fully informed of the risks and benefits of all available options, including non-surgical ones, they may later feel regret.
The patient’s role in the decision-making process also plays a part. A passive role in treatment decision-making has been linked to higher levels of regret, while an active role is associated with less regret. Feelings of anxiety before treatment, perceived time pressure, and lower satisfaction with the information provided by doctors can also exacerbate regret. Furthermore, some studies indicate that higher levels of regret are found in certain demographic groups and can increase over time.
Strategies to Reduce Regret
Minimizing the risk of regret after prostate surgery involves proactive steps from both patients and healthcare providers. Thorough pre-operative education is a foundational element, ensuring patients have a clear understanding of all treatment options, including surgical and non-surgical approaches like active surveillance or radiotherapy. This education should comprehensively cover the potential benefits, risks, and expected side effects of each option, helping to set realistic expectations about recovery and long-term quality of life.
Engaging in shared decision-making with healthcare providers is another important strategy. This process involves a collaborative discussion where patients and their doctors share information, personal values, and preferences to arrive at a mutually agreeable treatment plan. Patients who actively participate in this process and feel responsible for their treatment choice tend to experience less regret. Utilizing decision aids, such as comparison charts and detailed educational materials, can reinforce factual knowledge and empower patients to make informed choices.
Seeking support from peers or support groups can also be beneficial, providing a space for patients to discuss concerns and learn from others’ experiences. Asking detailed questions and seeking multiple consultations with different specialists, such as urologists and radiation oncologists, can provide a more complete picture of available options and their implications. Taking sufficient time to research and consider options, rather than feeling rushed into a decision, can further contribute to a sense of confidence in the chosen path.