Supportive Care in Cancer

, Volume 28, Issue 2, pp 507–514 | Cite as

Exploring the impact of providing men with information about potential prostate cancer treatment options prior to receiving biopsy results

  • Brindha PillayEmail author
  • Daniel Moon
  • Denny Meyer
  • Helen Crowe
  • Sarah Mann
  • Nicholas Howard
  • Addie Wootten
  • Mark Frydenberg
Original Article



There is little research assessing the impact of providing men with information about prostate cancer (PCa) treatment options at the time of referral for a prostate biopsy. Study objectives were to determine whether receiving an information booklet about PCa treatment options prior to receiving biopsy results was acceptable to patients, and if receiving this information influenced levels of anxiety, depression, distress, and treatment decisional conflict.


Between June 2016 and September 2017, a randomised block design was used to allocate patients from an Australian urology practice into the intervention or control group. Patients in the intervention group were provided with written information about treatment options for localised PCa prior to their biopsy. Outcome measures including the Distress Thermometer, Generalised Anxiety Disorder-7, Patient Health Questionnaire-9, and Decisional Conflict Scale were completed pre-biopsy and 2–3 weeks post-biopsy. Ninety-eight patients referred for an initial prostate biopsy for an elevated PSA test or suspicious digital rectal exam participated in the study (response rate = 78%).


Multimodal repeated-measures analyses showed no significant differences between control and intervention groups in changes in distress, anxiety, or depression from pre- to post-biopsy, and in decisional conflict post-diagnosis (all p > .05). Thirty-five (87%) patients believed that the resource made it easier to understand subsequent explanation of treatment options, and 51 patients (98%) who received the intervention preferred to be given information at that time.


Providing patients with information about treatment options prior to biopsy did not impact on changes in psychological distress and decisional conflict post-biopsy. However, the majority of patients preferred to be given such information at this time point.


Cancer Oncology Prostate biopsy Treatment decision aid Distress Decisional conflict 



The authors acknowledge the contribution of Prostate Cancer Foundation Australia.

Funding information

This study was supported by an Epworth Research Institute grant.

Compliance with ethical standards

This study was approved by the institution’s ethics committee (714-15).

Conflict of interest

The authors declare that they have no conflict of interest.

Authors had full access to all of the data (including statistical reports and tables) in the study.


  1. 1.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin D, Forman D, Bray F (2012) GLOBOCAN 2012 v1.0 cancer incidence and mortality worldwide. IARC CancerBase No. 11. International Agency for Research on Cancer, LyonGoogle Scholar
  2. 2.
    Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Potosky AL, Stanford JL, Stroup AM, Van Horn RL, Penson DF (2013) Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med 368(5):436–445. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hellenthal N, Ellison L (2008) How patients make treatment choices? Nat Clin Pract Urol 5(8):426–433CrossRefGoogle Scholar
  4. 4.
    Bosco JLF, Halpenny B, Berry DL (2012) Personal preferences and discordant prostate cancer treatment choice in an intervention trial of men newly diagnosed with localized prostate cancer. Health Qual Life Outcomes 10:123–123. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Zeliadt SB, Ramsey SD, Penson DF, Hall IJ, Ekwueme DU, Stroud L, Lee JW (2006) Why do men choose one treatment over another? A review of patient decision making for localised prostate cancer. Cancer 106(9):1865–1874CrossRefGoogle Scholar
  6. 6.
    Maguire R, Hanly P, Drummond FJ, Gavin A, Sharp L (2017) Regret and fear in prostate cancer: the relationship between treatment appraisals and fear of recurrence in prostate cancer survivors. Psychooncology 26(11):1825–1831. CrossRefPubMedGoogle Scholar
  7. 7.
    van Tol-Geerdink JJ, Willem Leer J, Weijerman PC, van Oort IM, Vergunst H, van Lin EN, Alfred Witjes J, Stalmeier PF (2013) Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid. BJU Int 111(4):564–573. CrossRefPubMedGoogle Scholar
  8. 8.
    Chabrera CM, Zabalegui A, Bonet M, Caro M, Areal J, Gonzalez JR, Font A (2015) A decision aid to support informed choices for patients recently diagnosed with prostate cancer: a randomized controlled trial. Cancer Nurs 38(3):E42–E50CrossRefGoogle Scholar
  9. 9.
    Isebaert S, Van Audenhove C, Haustermans K, Junius S, Joniau S, De Ridder K, Van Poppel H (2008) Evaluating a decision aid for patients with localized prostate cancer in clinical practice. Urol Int 81(4):383–388CrossRefGoogle Scholar
  10. 10.
    Violette PD, Agoritsas T, Alexander P, Riikonen J, Santti H, Agarwal A, Bhatnagar N, Dahm P, Montori V, Guyatt GH, Tikkinen KAO (2015) Decision aids for localized prostate cancer treatment choice: systematic review and meta-analysis. CA Cancer J Clin 65(3):239CrossRefGoogle Scholar
  11. 11.
    Ramsey SD, Zeliadt SB, Arora NK, Potosky AL, Blough DK, Hamilton AS, Van Den Eeden SK, Oakley-Girvan I, Penson DF (2009) Access to information sources and treatment considerations among men with local stage prostate cancer. Urology 74(3):509–515. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zeliadt SB, Moinpour CM, Blough DK, Penson DF, Hall IJ, Smith JL, Ekwueme DU, Thompson IM, Keane TE, Ramsey SD (2010) Preliminary treatment considerations among men with newly diagnosed prostate cancer. Am J Manag Care 16(5):e121–e130PubMedGoogle Scholar
  13. 13.
    Zeliadt SB, Hannon PA, Trivedi RB, Bonner LB, Vu TT, Simons C, Kimmie CA, Hu EY, Zipperer C, Lin DW (2013) A preliminary exploration of the feasibility of offering men information about potential prostate cancer treatment options before they know their biopsy results. BMC Med Inform Decis Mak 13(19).
  14. 14.
    Chambers SK, Zajdlewicz L, Youlden DR, Holland JC, Dunn J (2014) The validity of the distress thermometer in prostate cancer populations. Psychooncology 23:195–203CrossRefGoogle Scholar
  15. 15.
    Spitzer RL, Kroenke K, Williams JB, Lowe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097. CrossRefGoogle Scholar
  16. 16.
    Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9. J Gen Intern Med 16(9):606–613. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Pillay B, Moon D, Love C, Meyer D, Ferguson E, Crowe H, Wootten A (2017) Quality of life, psychological functioning, and treatment satisfaction of men who have undergone penile prosthesis surgery following robot-assisted radical prostatectomy. J Sex Med 14(12):1612–1620. CrossRefPubMedGoogle Scholar
  18. 18.
    Punnen S, Cowan JE, Dunn LB, Shumay DM, Carroll PR, Cooperberg MR (2013) A longitudinal study of anxiety, depression and distress as predictors of sexual and urinary quality of life in men with prostate cancer. BJU Int 112(2):E67–E75. CrossRefPubMedGoogle Scholar
  19. 19.
    O'Connor AM (1995) Validation of a decisional conflict scale. Med Decis Mak 15(1):25–30CrossRefGoogle Scholar
  20. 20.
    Ernstmann N, Weissbach L, Herden J, Winter N, Ansmann L (2017) Patient–physician communication and health-related quality of life of patients with localised prostate cancer undergoing radical prostatectomy – a longitudinal multilevel analysis. BJU Int 119(3):396–405. CrossRefPubMedGoogle Scholar
  21. 21.
    Grummet J (2017) How to biopsy: transperineal versus transrectal, saturation versus targeted, what’s the evidence? Urol Clin N Am 44(4):525–534. CrossRefGoogle Scholar
  22. 22.
    Hagerman CJ, Bellini PG, Davis KM, Hoffman RM, Aaronson DS, Leigh DY, Zinar RE, Penson D, Van Den Eeden S, Taylor KL (2017) Physicians’ perspectives on the informational needs of low-risk prostate cancer patients. Health Educ Res 32(2):134–152. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Epworth Prostate CentreEpworth HealthcareMelbourneAustralia
  2. 2.Urology, Royal Melbourne HospitalMelbourneAustralia
  3. 3.Psychosocial Oncology ProgramPeter MacCallum Cancer CentreMelbourneAustralia
  4. 4.Epworth Centre for Robotic SurgeryEpsworth HealthcareMelbourneAustralia
  5. 5.Australian Urology AssociatesMelbourneAustralia
  6. 6.University of MelbourneMelbourneAustralia
  7. 7.School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
  8. 8.Australian Prostate CentreNorth MelbourneAustralia
  9. 9.Urology, Monash HealthMelbourneAustralia
  10. 10.Clinical Institute of Specialty SurgeryEpworth HealthcareMelbourneAustralia
  11. 11.Department of SurgeryMonash UniversityMelbourneAustralia

Personalised recommendations