Decision-Making Dilemmas Among Elderly Prostate Cancer Patients Receiving 177Lu-PSMA Therapy: A Qualitative Study

Ying Chen,1 Chunyu Liu,1 Ruilian Li,1 Yaping He,1 Li Li2 1School of Nursing, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China; 2Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of ChinaCorrespondence: Li Li, Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China, Tel +86 13568624027, Email [email protected]: To explore the decision-making dilemmas experienced by elderly patients with advanced prostate cancer when considering 177Lu-PSMA therapy, and to provide evidence for the development of tailored decision-support strategies.Methods: A qualitative descriptive design was adopted. Using purposive sampling, 20 elderly prostate cancer patients who had received 177Lu-PSMA therapy at a tertiary hospital in China between April and June 2025 were recruited for semi-structured interviews. Data were analyzed following Braun’s style of thematic analysis.Results: Three overarching themes and nine subthemes were identified, reflecting multi-layered decision-making conflicts. (1) Decision-making triggers dilemma described information cognitive deficits, family value conflicts, and weak support systems that constrained patients’ understanding and autonomy. (2) Decision-conflicting perceptual dilemma captured uncertainty regarding treatment efficacy and emotional distress caused by disease progression and prior treatment experiences. (3) Coping-adaptive behavioral dilemma illustrated financial constraints, dependent decision tendencies, and varied coping strategies, alongside expressed needs for accessible and technology-supported tools. These findings reveal the complex interplay of cognitive, emotional, familial, and systemic factors influencing treatment decisions.Conclusion: Effective resource support can help elderly prostate cancer patients cope with various dilemmas during the 177Lu-PSMA treatment decision-making process. Nursing staff should address the actual needs of patients, explore the clinical application of emerging age-appropriate decision-support interventions, and construct decision-support programs tailored to patient characteristics, thereby helping patients develop positive coping mechanisms and enhancing their active participation as well as rational decision-making abilities.Keywords: elderly, prostate cancer, 177Lu-PSMA, dilemmas in decision-making, qualitative research, influencing factors