Patient Preferences for Treatment of Intermediate-risk Prostate Cancer: A Discrete Choice Experiment

Abstract

Objective To evaluate patient preferences for intermediate-risk prostate cancer treatment and determine how these preferences vary across demographic groups using a discrete choice experiment. Methods We recruited patients with intermediate-risk prostate cancer from a single-center urology clinic. In this survey, we included 8 attributes with 3-4 levels each to capture the full spectrum of prostate cancer treatment outcomes. We estimated patient preferences using a conditional logit model. We conducted a latent class analysis to identify patient subgroups with distinct choice behavior patterns. We used a multivariable linear probability model to assess the association between patient demographic characteristics and latent class membership. Results A total of 88 patients completed the survey. In our primary analysis, patients had a significant preference towards avoiding bowel symptoms, erectile dysfunction, use of a catheter, or frequent trips to the facility. Bowel symptoms were considered the most important of all attributes, while urinary symptoms did not significantly influence patients’ choices. Patients placed a low weight on facing prolonged travel times or undergoing a major surgery. Latent class analysis revealed 2 groups based on survey response patterns: (1) patients averse to surgery and catheter and (2) patients averse to erectile and bowel symptoms. Older patients and racial and ethnic minorities were more likely to be members of the surgery and catheter-focused class. Conclusion Overall, patients appear to prioritize avoiding bowel and sexual side effects after prostate cancer treatment. However, a subset of older patients may have strong preferences against surgery or the prolonged use of a catheter.