15250-m-cuypers

12 Chapter 1 develops at an older age, aging of our population, and the still increasing use of PSA testing contributes to an expected continued growth of Pca detection over the next decade 13, 24 . The probability of developing Pca at some point in life is estimated at just below 20%, while some studies showed that up to 50%of men between 70 and 80 years of age show some evidence of Pca 25 . However, most of these cancers will be non-aggressive and men will die of other causes without ever experiencing Pca symptoms 26 . Nevertheless, many men, when knowing that cancer is detected, feel the urgent need for treatment, even if the cancer might never develop symptoms and is unlikely to be fatal 27 . Preference-sensitive treatment options The most endorsed curative treatment options for Pca (surgery, brachy therapy, and external radiotherapy) promise comparable chances on successful treatment and long- time survival 14 . However, each treatment has specific side-effects that can significantly impair a patient’s quality of life (e.g. impotence, incontinence) 28-31 . These side-effects could even be perceived as worse than the cancer symptoms themselves. Alternatively, active surveillance can be a safe option for many men to postpone or avoid treatment without harming further survival perspectives. However, life then has to be continued with the knowledge of an untreated tumor being present 32, 33 . Without anobviously superior option, thebest suiting treatment for an individual patient depends on various factors and is preference-sensitive 34 . First, clinical characteristics such as tumor size, co-morbidities and the physical condition of the patient, determine eligibility for one or more treatments. Second, personality characteristics and individual preferences determine which treatment the patient feels most comfortable with. For example, Patient A’s fear for tumor progression may outweigh the perceived risk and burden of treatment side effects, resulting in a choice for surgery or radiotherapy. Patient B, on the other hand, might be reassured that active surveillance is as safe as immediate treatment, and chooses to postpone treatment and avoid the side effects associated to treatment. If patients’preferences would not be taken into account, and Patient A would be assigned to active surveillance, his daily life could be disturbed by anxiety about tumor progression, while if Patient B would have undergone surgery immediately and suffer from side effects, regret about the chosen treatment could impair quality of life to a greater extent in his case compared to a patient who accepted the risks of side effects as a consequence of immediate treatment upfront.