Preferences of healthy men for two different endocrine treatment options offered for locally advanced prostate cancer

OBJECTIVE: The aim of this study was to determine whether healthy men would prefer either luteinizing hormone releasing hormone analogues (LHRHa) or non-steroidal anti-androgen therapy (NSAA) should they hypothetically develop locally advanced prostate cancer. PARTICIPANTS AND METHODS: A representative sample of 180 men without prostate cancer (68% over 65 years of age, range 50-90 years), read two scenarios describing LHRHa or NSAA treatments for locally advanced prostate cancer. Participants chose which drug treatment they hypothetically would prefer, gave a reason for their choice and indicated the degree to which they wanted to avoid side effects specific to each drug. RESULTS: Eighty-six per cent (156/180) of the men chose NSAA therapy, 7% (12/180) chose LHRHa therapy and 7% (12/180) could not decide. The main reason men chose LHRHa therapy was because of the method of administration (9/12) whereas those who chose NSAA therapy cited avoidance of the side effects associated with LHRHa treatment (115/156). The side effects, ranked in order of importance, that men who chose NSAA therapy most wanted to avoid included risk of potential fractures (85%), reduced physical strength (76%), decreased sexual interest (56%), impotence (51%), hot flushes (49%), breast enlargement (17%) and breast tenderness (13%). CONCLUSION: Although this project was a hypothetical study, several important issues emerged from the data that are relevant to patient choice. Men should be fully informed about the side-effect profiles of different endocrine treatments, involved in decision making and allowed to choose therapies less likely to cause side effects they would prefer to avoid.