Although active surveillance is not a popular option for men with low-risk prostate cancer, the majority of those who choose it are satisfied with their selection.
Active surveillance has long been accepted by urologists as an appropriate treatment for some men with localized low-risk prostate cancer, but patients are less enthusiastic about this approach. In fact, only 8% to 10% of men actually choose active surveillance, noted first author Joyce Davison, PhD, RN, assistant professor of urologic sciences at the University of British Columbia.
"There is still controversy as to which treatment is more effective and less impactful on quality of life for men with low-risk prostate cancer," Dr. Davison noted during an oral presentation at the AUA annual meeting in San Francisco. "A minority of men opt for this treatment, but we found that they were quite happy with their decision to be on active surveillance."
The researchers used semi-structured interviews with 25 men treated at the Vancouver Prostate Centre to explore their decisions regarding active surveillance. The factors included physician recommendations, the attitude of each man's partner or spouse, the role the man played in making the final decision, and the resources men wanted to have available during active surveillance. The qualitative data were analyzed and used to design a three-part survey that was mailed to a cross-sectional sample of 110 men on active surveillance.
Of the 110 men surveyed, 64 completed the questionnaire. The mean age was 64.5 years. All respondents were between 2 and 8 years post-diagnosis, with 88% on active surveillance for less than 5 years. The majority were Caucasian, had a greater than high school education, and were married.
41% of men make decision with urologist
One-third of the men, 32%, reported that they allowed their urologist to make the active surveillance decision, while 27% made the decision on their own and 41% reported a collaborative decision with the urologist. Men who were age 70 or older tended to take a more passive role in the active surveillance decision than younger men, Dr. Davison reported.
The majority of men, 82%, reported that they were comfortable with their active surveillance decision, and 89% were satisfied with the choice. About 90% of men said they were able to obtain all the information they wanted while making the decision. In addition, 76% said it was similar to making any other important life decision, and 65% said it was not a difficult decision to make.
The single most important factor in choosing active surveillance was the urologist's recommendation, Dr. Davison noted, followed by the patient's age and concerns about the potential affects of more aggressive treatment on urinary continence and sexual function.
"The urologist has the greatest influence on the decision to go on active surveillance," she said. "The influence of a man's spouse or partner also plays an important role."
Most men, 71%, wanted to be able to access information on future treatment options. A majority of men, 52%, also wanted information on nontraditional treatment options, while 51% wanted recommendations on diet, and 38% wanted information on exercise.
"We need a broader study of active surveillance decisions, including men who fail active surveillance," Dr. Davison said. "And we clearly need to develop additional information support resources for these men while they are on active surveillance."