Project Overview +

Approximately 10-30% of men who undergo external beam radiation for localized prostate cancer see rising PSA scores following treatment. Some of these men need androgen deprivation therapy (ADT) as salvage treatment. ADT is not curative and has significant side effects that impact quality of life (QOL). These facts must be balanced against its clinical need.

The decision to initiate hormonal therapy is driven more by patient anxiety and less by clinical parameters. Thus, men need to better understand how their PSA values and likelihood of recurrence will change over time.

A novel computer model, based on 2,386 patients previously treated, provides this information. This project aims to develop and test methods of communicating this information to patients and to determine how patients use it in their treatment decisions.

Aims +

Aim 1. Develop several graphical methods for presenting the key pieces of numerical information in regard to predicted PSA response and clinical failure.

Aim 2: Pilot test the materials in urology and RT clinics to determine the best method for communicating the information to patients. Based on pilot testing, choose one graphical format for further evaluation.

Aim 3: Using the identified graphical format, test the use of these materials in encounters with patients who are actually making decisions regarding ADT. We assess anxiety, knowledge, risk perceptions, actual behavior in regard to ADT, self-efficacy for making a treatment decision, and satisfaction with the tool.

Participants +

Pilot test (Aim 1): patients in Radiology clinic waiting rooms

Phase 2 trial (Aim 3): 50 eligible patients in the radiology clinic population and University of Michigan and the University of Chicago

Intervention +

Subjects are randomized to either receive a tailored or untailored health education material. All subjects receive a description of the role of ADT and a description of the benefits (rapid fall in PSA, decrease in risk of systemic or skeletal metastases) and risks (fatigue, hot flashes, loss of libido, weight gain, rise in serum triglycerides, loss of lean body mass, osteopenia, a propensity to insulin resistance, and potential worsening of coronary artery disease) of ADT.

Those randomized to receive the tailored aid also receive the tailored instrument (as developed in Aims 1 and 2), which details the unique risk in regard to their prostate cancer for which hormonal therapy may be beneficial. These risk statistics are based on the computer model completed in earlier research.