Radiotherapy Is the Favored Treatment for Localized Prostate Cancer Among Those Living Remotely

Men with localized prostate cancer were most likely to select treatment with radiotherapy over surgery and its associated adverse effects.

Despite not being available locally, men with localized prostate cancer who lived in remote areas were more likely receive treatment with radiotherapy due to disease stage and not income, according to a study published in the Canadian Urological Association Journal.1

Radiotherapy was the chosen treatment for 67.7% of men living in remote areas, compared with 22.8% who received surgery, or 9.4% who received active surveillance. Investigators found that the cancer stage was the only factor associated with patient’s choice to receive radiotherapy (OR, 10.15; 95% CI, 3.18–32.40; P = .0001).

“Radiotherapy was the most frequently chosen treatment, although unavailable locally. Most patients preferred an active involvement in treatment decision-making. Furthermore, our analyses suggest that over one-third of patients were unsure of the choice to make and that 7.9% regretted their choice,” investigators of the study wrote.

A total of 169 patients filled out and returned a questionnaire, with the convenience sample consisting of 127 patients who had been diagnosed with localized cancer and needed to make a treatment choice . The mean patient age was 68.34 years, 52.7% of whom had not completed post-secondary education. Additionally, 48.8% of patients had an annual family income ranging from $20,000 to $39,000.

Investigators reported that 82.5% of patients had a clinical tumor stage of T2a or more at diagnosis. Additionally, 84.25% had a Gleason score of 6 or 7, and 15.75% had a score of 8 or 9; no patients had a score of 10. Among the patients who were treated with external radiotherapy (38.6%), 4.7% received hormonotherapy as part of a combination regimen.

The Control Preference Scale indicated that 53.5% of patients preferred to be active decision makers. Moreover, findings from the SURE test, the Canadian French clinical version of the Decision Conflict Scale, indicated that 31.5% of patients were not confident in their decisions. Patients were informed by a variety of sources prior to making treatment decisions, including their physicians (77.2%), spouses (36.2%), and others who have experienced prostate cancer (34.6%). Notably, 18.9% of patients consulted a nurse. Additionally, 86.6% of patients agreed with the statement “I chose this treatment because it gives the best chance for a cure”.

The univariable and multivariable model showed that patients with a lower cancer stage were more likely to choose an out-of-region treatment strategy. Age and income were not associated with treatment choice (P >.05). Investigators indicated that the sensitivity analysis did not change the conclusions, including all sociodemographic factors and clinically relevant variables.

“Our study population had a relatively low economic status. It is, therefore, both surprising and interesting that radiotherapy was the most frequently chosen treatment. This is not consistent with results published by Timilshina et al, which showed that active surveillance was the treatment most frequently chosen by patients living in another remote region in Quebec,” concluded investigators.2


  1. El-Haouly A, Dragomir A, El-Rami H, Liandier F, Lacasse A. Treatment decision-making in men with localized prostate cancer living in a remote area: a cross-sectional, observational study. Can Urol Assoc J. 2021;15(3):E160-E168. doi:10.5489/cuaj.6521
  2. Timilshina N, Ouellet V, Alibhai SMH, Mes-Masson AM, et al. Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study. World J Urol. 2017;35(4):595-603. doi:10.1007/s00345-016-1897-0