Do Men Regret Their Prostate Cancer Treatment Choice?”

How Common Is Treatment Regret in Prostate Cancer?

Treatment regret is a recognised concern among men with localised prostate cancer, with research showing that many patients wish they had chosen differently — particularly when side effects affect sexual function or urinary continence. At The Focal Therapy Clinic, our experience with over 2,000 focal therapy procedures shows that informed, shared decision-making significantly reduces the likelihood of regret.

Many of our patients come to us after hearing about family members or friends who experienced regret following prostate cancer treatment. This drives them to seek a second opinion and explore focal therapy as an alternative to radical surgery or radiotherapy.

Recent studies from Harvard Medical School and other leading institutions now provide robust evidence on the scale and causes of decision regret, supporting what our consultants see in clinical practice.

A study conducted at Harvard Medical School and published in JAMA Oncology examined treatment regret amongst 2,072 prostate cancer patients between three and five years after treatment. The research confirmed that treatment-related regret is associated with poorer mental health and reduced quality of life — underscoring the importance of getting the treatment decision right from the outset.

The study focused on men with localised prostate cancer — the same patient group who may be suitable for focal therapy. Among the 2,072-patient cohort, treatment-related regret was common, with rates differing by treatment type. Men who underwent surgery or radiotherapy and experienced significant side effects reported the highest levels of regret.

Crucially, regret was “associated with functional outcomes and patient expectations” — meaning men who experienced worse-than-expected sexual dysfunction, urinary incontinence, or bowel problems were most likely to wish they had chosen differently. This finding aligns with why many men now explore focal therapy options such as HIFU (NICE-approved under IPG424) and NanoKnife IRE (NICE-approved under IPG768), which aim to preserve these functions.

What Causes Regret After Prostate Cancer Treatment?

A landmark study published in the Journal of Clinical Oncology followed localised prostate cancer survivors for 15 years to understand what drives long-term treatment regret. The findings are clear: side effects and lack of informed decision-making are the strongest predictors of regret, regardless of whether the patient remained cancer-free.

The study evaluated men diagnosed before the age of 75, assessing their quality of life, treatment satisfaction, and decision-making experience over a decade and a half after treatment.

The study identified clear factors that predict whether a man will regret his treatment decision:

• Sexual dysfunction — men reporting moderate or significant problems with sexual function were far more likely to experience regret
• Urinary incontinence — ongoing urinary problems strongly predicted decision regret
• Bowel dysfunction — bowel-related side effects, particularly after radiotherapy, contributed to regret
• PSA anxiety — persistent concern about rising PSA levels was associated with higher regret

Encouragingly, two factors were associated with less regret: increasing age at diagnosis and having made a fully informed treatment decision. This underscores why seeking a second opinion and understanding all available options — including focal therapy — is so important.

At The Focal Therapy Clinic, our outcomes data directly addresses the side effects most associated with regret. In our audit of 265 patients, 97% maintained urinary continence and 90%+ preserved sexual function following focal therapy (FTC audit, n=265).

The study’s conclusions are striking:

“Lack of informed decision making was highly associated with regret, regardless of whether the patient reported being cancer free. Men should be made aware of treatment options, their respective risks and benefits, and be engaged with their providers in making value-concordant decisions.”

Two key insights emerge from this research:

• Overtreatment causes regret — men who had no complications or recurrence still expressed regret if they came to believe their treatment was unnecessary, particularly those with low-risk disease suitable for active surveillance
• Passive decision-making increases regret — men who took an active role in their treatment choice reported significantly less regret than those who deferred entirely to their clinician

Does Focal Therapy Reduce Treatment Regret?

The evidence strongly suggests it does. A 2021 study published in the Journal of Urology found that over 80% of focal therapy patients would make the same treatment choice again, and fewer than 10% reported any decision regret — substantially lower than the regret rates seen after radical surgery or radiotherapy.

This aligns with the clinical experience at The Focal Therapy Clinic, where our consultants have collectively performed over 2,000 focal therapy procedures. Our patient data shows 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265) — directly addressing the side effects most strongly linked to treatment regret in the research.

“Not every patient is suitable for focal therapy, and we’re transparent about that. We assess every referral carefully with mpMRI and targeted biopsy before recommending treatment.”

How Can You Avoid Regret When Choosing Prostate Cancer Treatment?

The research is clear: informed, active decision-making is the single most effective way to reduce treatment regret. Men who understand all available options — including focal therapy, surgery, radiotherapy, and active surveillance — and who discuss the risks, benefits, and expected outcomes with their clinical team report significantly less regret, regardless of which treatment they choose.

At The Focal Therapy Clinic, our consultants specialise in helping men navigate this decision. Our patient pathway includes:

• Expert review of your MRI — detailed assessment of your scans by specialist uroradiologists
• Multidisciplinary discussion — your case reviewed by a team of consultant urological surgeons experienced in focal therapy
• Transparent outcome data — we share our own clinical results (90%+ sexual function preservation, 97% continence rate) so you can make a fully informed comparison
• Honest suitability assessment — not every man is suitable for focal therapy, and we will tell you clearly if another approach is more appropriate for your cancer

If you have been diagnosed with localised prostate cancer and would like a second opinion on your treatment options, our team of consultant urological surgeons — who have collectively performed over 2,000 focal therapy procedures across seven UK locations — can help you make a confident, informed decision.

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