Impact of diagnostic labels and management benefit-to-harms information for low-risk prostate pathology.

OBJECTIVES

To evaluate the effects of diagnostic labels and management benefit-to-harms information for low-risk prostate pathology.

METHODS

Two factorial (3x2) online hypothetical experiments randomised participants 11:1 to three labels: "low-risk prostate cancer, Gleason Group 1", "low-risk prostate neoplasm", or "low-risk prostate lesion", with second randomisation 1:1 to high or low information on management options. Participants were Australians aged ≥50 years with a prostate (males) or with a male partner aged ≥50 years (females). The primary outcome was preference for management with curative-intent (prostatectomy; radiation therapy) or conservative management (PSA monitoring; active surveillance).

RESULTS

For 1340 males and 1435 females randomised April to June 2024, 50% vs 34% preferred PSA monitoring, 37% vs 46% active surveillance, 7% vs 11% prostatectomy, and 7% vs 8% radiotherapy. The "neoplasm" label reduced preference for curative-intent treatment in both males (low information Risk Difference (RD)-3.9%[95% CI:-10.5%,2.7%], high information RD: -5.2%[95% CI:-10.6%,0.2%]) and females (low information RD:-6.6% [95% CI:-14.3%,1.1%], high information RD: -2.3%[95%CI:-8.9%,4.3%]). The "lesion" label reduced preference for curative-intent treatment in females within low information groups (RD:-11.6%[95%CI:-18.9%,-4.3%]) but had minimal effect in males and in females within high information groups. High information reduced preference for curative-intent treatment within "cancer" label in both studies (males RD:-4.0%[95% CI:-10.5%,2.5%]; females RD:-10.3%[95%CI:-17.7%,-2.9%]). The combination of "neoplasm" and high information resulted in the largest effects (males RD:-9.2%[95%CI:-15.1%,-3.3%]; females RD:-12.6% [95% CI: -19.9%, -5.2%]).

CONCLUSIONS

Clear communication about management benefit-to-harms, and using "neoplasm" to describe low-risk prostate pathology may support conservative management choices and mitigate overtreatment.

TRIAL REGISTRATION: ANZCTR 386701;386889.