Jonathan D. Tward, MD, PhD, FASTRO, presented “The Undecided PCA Consult: Optimized Counseling, Treatment Choices, Avoiding Decision Regret” during the 35th International Prostate Cancer Update conference on February 9, 2025, in Vail, Colorado.
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How to cite: Tward, Jonathan D. “The Undecided PCA Consult: Optimized Counseling, Treatment Choices, Avoiding Decision Regret.” February 9, 2025. Accessed Nov 2025. https://grandroundsinurology.com/the-undecided-pca-consult-optimized-counseling-treatment-choices-avoiding-decision-regret/
The Undecided PCA Consult: Optimized Counseling, Treatment Choices, Avoiding Decision Regret – Summary
Jonathan D. Tward, MD, PhD, FASTRO, Professor of Radiation Oncology, University of Utah, Salt Lake City, Utah, addresses decisional regret in prostate cancer treatment. In this 16-minute presentation, Dr. Tward emphasizes the complexity of patient choice and the impact of multidisciplinary consultation.
Dr. Tward highlights that patients often struggle with overwhelming information. Data shows that treatment decisions are heavily influenced by which specialist patients consult. Surgery is most common after seeing only a urologist, while multidisciplinary engagement increases the likelihood of patients exploring alternative therapies like radiation.
Using the PROTECT trial, Dr. Tward demonstrates that for low-risk prostate cancer, there is no significant difference in survival outcomes between surgery, radiation, or active surveillance. For high-risk patients, data from large studies reveal similar outcomes between prostatectomy and external beam radiation with hormone therapy, although combining radiation with brachytherapy shows superior results. The PACE A trial indicates that radiation reduces urinary incontinence and improves sexual function compared to surgery, but prostatectomy shows better outcomes for urinary obstruction and bowel function.
Dr. Tward stresses that decisional regret stems largely from unmet expectations about treatment outcomes and side effects. He advocates for multidisciplinary consultations, transparent risk communication, and ongoing patient support.
About the 35th International Prostate Cancer Update:
The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 35 will feature lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.
The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts. You can learn more about the conference here.
ABOUT THE AUTHOR
Jonathan D. Tward, MD, PhD, FASTRO is a tenured Professor in the Department of Radiation Oncology at the University of Utah, where he also serves as the physician lead on several operational committees and working groups.. Dr. Tward holds the The Vincent P. and Janet Mancini Presidential Endowed Chair at Huntsman Cancer Institute (HCI) in Genitourinary Malignancies and is the leader of the HCI Genitourinary Cancers Center (GUCC). In that role, Dr. Tward is responsible for the strategic vision and operations of the GUCC, including the multidisciplinary collaboration of patient care, community engagement, research, and donor relations. Before joining HCI, Dr. Tward founded and served as the CEO or on the Board of Directors for several pioneering ecommerce and health-related websites. Dr. Tward earned a bachelor's degree in biology at the University of California, Los Angeles, a PhD in biochemistry, and an MD at Tufts University in Boston, Massachusetts. He completed a residency in radiation oncology at the University of Utah.
Dr. Tward is an expert at delivering highly precise and targeted radiation therapy to people afflicted with cancers of the prostate, bladder, kidney, testis, and penis. He uses the vast array of technologies available at the HCI to deliver intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), stereotactic body radiotherapy (SBRT), as well as low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy.
As a practicing physician and scientist, mentor, and educator, Dr. Tward has contributed to over 80 published-peer reviewed journal articles. He is the Principal Investigator (PI) on several ongoing investigator-initiated clinical trials and is the site PI on numerous cooperative group or industry-sponsored clinical trials. Dr. Tward serves as the Utah State Captain for the American Society of Radiation Oncology (ASTRO) and on the National Comprehensive Cancer Networks (NCCN) clinical practice guidelines committees for prostate, bladder, and penile cancers. As a member of the NCCN Framework for Resource Stratification subcommittees, Dr. Tward helps define appropriate cancer treatment pathways of low- and middle-resource countries where specific diagnostic tests or treatment approaches may be unavailable.
