Shared Decision-Making and Treatment Adherence

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Shared decision-making in androgen deprivation therapy (ADT) selection involves balancing medical expertise with patient values, preferences, and life circumstances. Real-world examples demonstrate how oral ADT facilitates this process, particularly for younger patients with high-quality baseline function who fear long-term treatment commitment. The ability to offer a trial period with oral therapy reduces treatment anxiety and allows patients to make informed decisions based on personal experience rather than theoretical concerns.

For patients with unfavorable intermediate-risk disease undergoing radiation therapy, the option to discontinue oral ADT if adverse effects become intolerable provides an acceptable risk-benefit trade-off. Some patients may choose to accept slightly higher recurrence risk in exchange for maintained quality of life, a decision that can only be made through genuine shared decision-making. The rapid reversibility of oral ADT makes this approach feasible without long-term consequences.

At the opposite end of the spectrum, older patients with questionable performance status benefit from low-risk treatment initiation with oral ADT. The ability to stop treatment immediately if clinical status deteriorates provides a bridge between active treatment and palliative care approaches. This flexibility enables more patients to attempt potentially beneficial therapy while maintaining the option to adjust treatment intensity based on tolerance and response. The psychological benefit of treatment control significantly enhances patient satisfaction and treatment adherence.