Black men are more likely to report decisional regret over localized prostate cancer (PCa) treatment than men of other races, according to new study findings.

Investigators analyzed survey responses from 146 (38.73%) Black patients and 231 (61.27%) non-Black patients matched by PCa pathology, age, treatment type, and other factors from the Cleveland Clinic. All patients answered 4 surveys, including a novel Prostate Cancer Beliefs Questionnaire (PCBQ), the Decisional Regret Scale, the Expanded Prostate Cancer Index Composite (EPIC) 26, and a modified EPIC demographics form.

Decisional regret score, reflecting distress upon consideration of an alternative treatment choice, was significantly higher/worse (44.74 vs 34.65) among Black patients than non-Black patients, Molly E. DeWitt-Foy, MD, of the Cleveland Clinic in Cleveland, Ohio, and colleagues, reported in the Journal of Urology. On multivariable analysis, Black men had significant 2.5-fold increased odds of expressing decisional regret compared with non-Black men after adjusting for potential confounders. Poorer sexual function, worse urinary incontinence, and younger age predicted decisional regret, but treatment type, relationship status, income, and education did not. Active surveillance was protective against a higher decisional regret score.

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On univariate and multivariable analyses, Black race significantly predicted 1.4-fold higher PCBQ-medical mistrust and masculinity scores, and these scores strongly and significantly correlated with decisional regret independent of race.

“African American men suffer worse decisional regret than non-African American men, which may be partially explained by higher medical mistrust and concerns about masculinity as captured by the Prostate Cancer Beliefs Questionnaire,” the investigators concluded. “This novel survey may facilitate identifying targets to reduce racial disparities in prostate cancer.”

The PCBQ asked patients whether they agreed or disagreed with statements on medical mistrust, masculinity, and PCa risk factors. More Black than non-Black men believed “My doctor treats me differently because of my race/ethnicity,” although the vast majority of Black respondents (nearly 80%) disagreed with this sentiment. Significantly more Black men believed that “it’s easier to get PCa because of my ethnicity/racial background” (43.66% vs 5.22%), but half of Black men did not know. Significantly more Black men expressed that “Prostate cancer treatment made me feel like less of a man” (21.98% vs 16.15%) and felt that a PCa diagnosis is “like a death sentence” (14.69% vs 5.62%), compared with men of other races.

Most survey participants chose their PCa treatment because of a conversation with their doctor. According to Dr Foy’s team, the PCBQ may prove an insightful patient screening tool. Decisional regret is associated with lower quality of life after PCa treatment, they noted, and might trigger symptoms.

“Our hope is that our findings, that cancer beliefs, concerns about masculinity and medical mistrust are key drivers of decisional regret, particularly among African American men, can inform the medical community about how to best prevent poor outcomes in at risk populations,” Dr Foy’s team stated. They placed the onus on the healthcare system to identify structural racism above improving patient literacy.


DeWitt-Foy ME, Gam K, Modlin C, Kim SP, Abouassaly R. Race, decisional regret and prostate cancer beliefs: Identifying targets to reduce racial disparities in prostate cancer. J Urol. 2021;205:426-4333. doi:10.1097/JU.0000000000001385