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. 2025 Jul 19:54:101019.
doi: 10.1016/j.ctro.2025.101019. eCollection 2025 Sep.

Decision regret after reirradiation of the primary site in patients with prostate cancer

Alexander Fabian  1   2 , Bilgesu Sahin Öztürk  1 , Lars Haack  1 , Severin Rodler  3 , Christof van der Horst  4 , Christian Schulz  1 , Claudia Schmalz  1 , Stefan Huttenlocher  1   2 , Olaf Wittenstein  1   2 , Oliver Blanck  1   2 , Frank-André Siebert  1 , David Krug  1   5
Affiliations

Decision regret after reirradiation of the primary site in patients with prostate cancer

Alexander Fabian et al. Clin Transl Radiat Oncol. .

Abstract

Purpose: A subset of prostate cancer patients develops local relapse at the primary site after radiotherapy. The optimal local salvage strategy is unknown. Therefore, we aimed to explore prevalence and determinants of decision regret among patients after reirradiation of the primary site.

Materials and methods: We surveyed 31 patients in a cross-sectional bi-centre exploratory study. Reirradiation was high dose-rate brachytherapy (HDR-BT) in 21 and stereotactic body radiotherapy (SBRT) in 10 patients. Decision regret (DR) was measured using the Decision Regret Scale (DRS) (range: 0-100; higher values higher regret). Further patient-reported outcomes (PRO) included the EPIC-26, EORTC QLQ-C30, PRO-CTCAE, and PSCC questionnaires. Univariable associations of decision regret and potential determinants were assessed by one-way ANOVA or Pearson's correlation.

Results: Median age at reirradiation was 75 years. Median time intervals from initial radiotherapy to reirradiation was 8 years and 4 years from reirradiation to survey. The mean DRS score was 10 (SD: 14). No (0 points), mild (1-25 points), or strong regret (>25 points) was reported by 45 % (14/31), 48 % (15/31), and 7 % (2/31) of the patients, respectively. DR was significantly associated with PRO of urinary symptom burden and toxicity as well as levels of shared-decision making and patient satisfaction. HDR-BT vs. SBRT, further local relapse, and progression-free survival were not associated with DR.

Conclusions: DR was mild among prostate cancer patients after reirradiation to the primary site. PRO on symptom burden and shared decision making may be associated with DR. These findings should be validated and may inform treatment decisions on local salvage therapy.

Keywords: Brachytherapy; Decision regret; Health-related quality of life; Patient-reported outcome; Prostate cancer; Radiotherapy; Reirradiation; SBRT; Stereotactic body radiotherapy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. AF has received honoraria from Merck Sharp &Dohme and a research award from Lilly Deutschland Stiftung.DK has received honoraria from Astra Zeneca, best practice onkologie, ESO, ESMO, Gilead, med update, Merck Sharp & Dohme, Novartis, onkowissen, and Pfizer, as well as research funding from Stiftung Deutsche Krebshilfe and Merck KGaA. OW received honoraria and travel grants from Brainlab AG and novocure AG.SR has received honoraria from BMS, Merck, MSD and Novartis and has equity interest in Rocketlane Medical Ventures GmbH. All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Oncological outcomes of participating prostate cancer patients (n = 31) after reirradiation of the primary site. Kaplan-Meier estimators are shown with corresponding 95 % confidence intervals. Panel A, B, C, and D show biochemical relapse, local relapse, distant relapse, and progression-free survival rates, respectively.
Fig. 2
Fig. 2
Toxicity at survey of patients (n = 31) after reirradiation of the primary site as measured by PRO-CTCAE composite grades.
Fig. 3
Fig. 3
Decision regret among prostate cancer patients (n = 31) after reirradiation of the primary site as per Decision Regret Scale. Panel A displays the distribution of the Decision Regret Scale score (range: 0–100; maximum value in our cohort: 55). Panel B depicts categories of no regret (0 points), mild regret (1–25 points), and strong regret (>25 points).
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