Abstract
Introduction: The aim of this study was to investigate non-adherence rates to adjuvant radiotherapy (aRT) after radical prostatectomy (RP) and to obtain patient reported reasons for rejecting aRT despite recommendation by a multidisciplinary team discussion (MTD). Methods: In a retrospective monocentric analysis, we identified 1,197 prostate cancer patients who underwent RP between 2014 and 2022 at our institution, of which 735 received a postoperative MTD recommendation. Patients with a recommendation for aRT underwent a structured phone interview with predefined standardised qualitative and quantitative questions and were stratified into “adherent” (aRT performed) and “non-adherent” groups (aRT not performed). Results: Of 55 patients receiving a recommendation for aRT (7.5% of all RP patients), 24 (44%) were non-adherent. Baseline tumour characteristics were comparable among the groups. “Fear of radiation damage” was the most common reason for rejection, followed by “lack of information,” “feeling that the treating physician does not support the recommendation” and “the impression that aRT is not associated with improved oncological outcome.” Salvage radiotherapy was performed in 25% of non-adherent patients. Conclusion: High rates of non-adherence to aRT after RP were observed, and reasons for this phenomenon are most likely multifactorial. Multidisciplinary and individualized patient counselling might be a key for increasing adherence rates.
Plain Language Summary
In men with aggressive prostate cancer, the addition of radiotherapy after the removal of the prostate through surgery (radical prostatectomy) is sometimes recommended. Our investigation focused on understanding why certain men opted against this additional radiotherapy. Our study included 1,197 men who underwent surgery between 2014 and 2022. Through interviews with men recommended for radiotherapy, we aimed to comprehend the reasons behind their choices – categorized as adherent (choosing radiotherapy) or non-adherent (not choosing radiotherapy). Out of the 55 men advised for radiotherapy, 31 (56%) opted for it, while 24 (44%) did not. The primary rationale for not choosing radiotherapy was fear of radiation damage. Other contributing factors included insufficient information, perceived lack of doctor support, and scepticism about the therapy’s efficacy in improving cancer outcomes. In conclusion, a noteworthy number of men did not adhere to the recommended additional radiotherapy post-prostate surgery. Acknowledging the diverse factors influencing men’s decisions, it is crucial for doctors to provide personalized counselling that addresses individual concerns.
