Purpose: Measures of preferences for prostate cancer treatment have incorporated attributes such as urinary, sexual, and bowel symptoms, and anxiety about mortality. While recent work has identified a broad range of prostate cancer treatment outcome domains, including self-concept and masculinity, it is not clear that men consider these impacts in making their treatment decisions. In this qualitative study, we sought 1) to determine whether African American (AA) and Caucasian American (CA) men describe an expanded range of attributes in narratives about prostate cancer treatment decisions and 2) to examine the extent of overlap in the attributes and processes described by AA and CA men.

Methods: 16 AA and 45 CA men diagnosed with localized prostate cancer were recruited from VA urology clinics and consented to participate in focused group sessions. Each of the 13 groups was homogeneous in ethnicity (i.e., AA, CA) and type of primary treatment (i.e., radical prostatectomy, brachytherapy, external beam radiation therapy, and watchful waiting). Two experienced moderators were trained in the specific study methods and conducted the groups. Moderators and groups were matched by gender and ethnicity. Content coding was conducted to identify attributes relevant to prostate cancer treatment decisions; Nvivo software was used to manage the analysis.

Results: In addition to symptoms such as sexual and urinary function, both AA and CA men described a wide range of attributes considered in making prostate cancer treatment decisions. The men mentioned concerns about how treatment would influence marital, family, and social relationships apart from sexuality, impacts to self-concept and masculinity, and considerations related to family, work, and community responsibilities. Also, AA men described prostate cancer as an African American burden, and mentioned stigma and trust in health professionals as additional concerns in making prostate cancer treatment decisions.

Conclusions: These data suggest that an expanded range of attributes is likely to be important in prostate cancer treatment decisions for both AA and CA men. While there was considerable overlap in the mentions, AA men described unique influences on the decision making process. This work suggests that an expanded conceptual framework may be important for understanding and measuring patient values and goals relevant to prostate cancer treatment decisions.