Purpose. Our purpose was to understand if and how the reversibility of a treatment affects prostate cancer decision-making. Of the many treatments for prostate cancer, none is clearly superior and some are irreversible. Men are given autonomy about treatment decision-making and face the decision under conditions of great uncertainty. Evidence from psychology and economic theory suggests that under conditions of uncertainty, the reversibility of a choice can influence both a decision and the timing of the decision if there is perceived value in postponing the choice.

Methods. We conducted secondary analysis of previously collected data in a qualitative study of men with localized prostate cancer (LPC) diagnosed in the previous 6 months: 15 men in focus groups and 31 individual unstructured interviews. We evaluated the transcripts for participant references to the reversibility of treatment options, timing of decision-making, and conditions of uncertainty, and organized them according to emerging themes. We also captured related themes that consistently appeared in discussions of our three themes of interest.

Results. The mean age of the sample was 68.4 (SD=9.3), 84.5% white, 70.5% married. Men considered the reversibility of a choice when making treatment decisions, comparing the decision to “slamming a door shut” or “buying shoes.” Others reported controlling the timing of the decision to be important, wanting to keep options open and take the time to consider all options to avoid later anticipated regret and be able to still make treatment decisions “down the road.” Many men considered “the way I make decisions” an important part of their decision process and described their decision-making processes in ways consistent with a desire for certainty: deciding quickly to “get it over with,” taking more time to “explore options”, or placing heavy emphasis on numeric probabilities. Men also described the disagreement among experts about a best treatment course as a source of further uncertainty.

Conclusions. Men with LPC, unprompted in open-ended interviews, report considering the reversibility of a treatment in prostate cancer treatment decision-making. They also report desires to control the timing of their decision and the importance of reducing uncertainty. Future research should explore the frequency and magnitude of reversibility in the treatment decision. Our findings may help inform interventions assisting men in the prostate cancer treatment decision.