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 Oct 2026. 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 Professor of Radiation Oncology at the University of Utah in Salt Lake City. Dr. Tward also holds the Vincent P. and Janet Mancini Presidential Endowed Chair in Genitourinary Malignancies at Huntsman Cancer Institute (HCI) and directs HCI’s Genitourinary Cancers Center in Salt Lake City, Utah. He is an internationally recognized pioneer in AI–driven digital and molecular oncology. Dr. Tward’s hybrid expertise in clinical oncology, computational science, and molecular biomarker discovery positions him as a global leader shaping the future of AI-powered digital and molecular oncology.
