Patient expectations of benefit from systemic treatments for metastatic prostate cancer

Background: Metastatic prostate cancer is incurable, but systemic therapies can improve quality of life and prolong survival. Accurate perceptions of treatment risks and benefits are vital as patients with metastatic disease make treatment decisions. We assessed treatment-related expectations for benefit among patients with metastatic prostate cancer and explored associated sociodemographic characteristics. Methods: Men with metastatic prostate cancer (N = 100) completed surveys assessing their treatment-related expectations for cancer cure, symptom relief, and prolonged life expectancy. Frequencies were used to describe the proportions of reported expectations. Fisher's exact tests were used to assess the associations of sociodemographic characteristics with treatment expectations. Results: One third (33%) of participants believed treatment was at least a little likely to cure their metastatic cancer. Most participants believed treatment could provide symptom relief (76%) and extend life expectancy (95%). Among participants reporting that cancer cure was at least a little likely vs not at all, more men identified as non-white (24% vs 5%; P =.01), self-reported good health (90% vs 58%; P <.01), and had greater optimism (78% vs 47%; P <.01). Among participants reporting that symptom relief was at least a little likely vs not at all, more men were less than 70 years old (62% vs 0%; P =.01). Conclusion: A large proportion of patients with metastatic prostate cancer reported beliefs inconsistent with understanding that treatment was not curative. Race, better self-reported health, and greater optimism were related to unrealistic expectations. Efforts to ensure alignment of patient and clinician expectations may facilitate more effective shared decision-making for treating metastatic disease.