Patient Preferences and ADT Options

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Patient preferences play a pivotal role in androgen deprivation therapy (ADT) selection, with most patients favoring oral therapy when presented with comprehensive information about available options. Factors influencing patient choice include needle phobia, desire for treatment autonomy, concern about long-term commitment, and preference for rapid reversibility. The minority of patients who prefer injectable therapy typically value infrequent clinic visits, have concerns about daily pill-taking, or experience cognitive changes that complicate medication management.

The psychological impact of treatment reversibility cannot be understated, particularly for patients with high baseline quality of life or physically demanding occupations. The ability to discontinue oral ADT with rapid testosterone recovery provides reassurance that encourages treatment initiation among hesitant patients. This "test drive" approach allows patients to experience ADT effects firsthand while maintaining the option to discontinue if side effects become intolerable.

From an insurance perspective, patient preferences can facilitate approval processes, with documented needle phobia or cardiovascular risk factors serving as justification for oral ADT selection. The rapid onset and reversibility of oral agents make them particularly suitable for patients uncertain about their ability to tolerate ADT, including elderly patients with marginal performance status who might otherwise defer treatment. This flexibility enables more patients to access potentially life-extending therapy while maintaining quality of life considerations.