Long-term Psychological and Quality-of-life Effects of Active Surveillance and Watchful Waiting After Diagnosis of Low-risk Localised Prostate Cancer

Patient Reported Outcome Measures for Transperineal Template Prostate Mapping Biopsies in the PICTURE Study

“…PROMs have become the new standard for evaluating the patient experience, and progressively being used to shape the way healthcare is funded, provided and managed. 7 This has included studies using PROMs for various modalities of prostate cancer treatments across all grades of disease including active surveillance, watchful waiting, brachytherapy, radical radiotherapy, prostatectomy have also been extensively reported in literature [9][10][11][12] .…”

Should we rename low risk cancers?

“…A non-cancerous label could affect the level of support for which the patient is eligible, although this may be less important in low risk tumours. However, removing the cancer label would not prevent serious psychosocial and financial consequences if accompanied by a recommendation for protracted follow-up, as is the case for active surveillance for prostate cancer 17…”

Renaming low risk conditions labelled as cancer

“…Recent studies in men with localised prostate cancer have found that the emotional distress of the diagnosis may motivate them to choose more aggressive treatment 28. However, not treating prostate cancer and following active surveillance also increases men’s levels of anxiety, rates of depression, and fear of cancer recurrence 29. Importantly, almost a quarter of men who initially choose to manage their prostate cancer with active surveillance opt for surgery or radiation therapy within five years for non-biological reasons 27…”

“…A population based prospective cohort study of 341 men showed that at 9-11 years after diagnosis men with low risk localised prostate cancer who started active surveillance or watchful waiting had higher levels of distress and hyperarousal than men who had radiation or high dose brachytherapy (adjusted mean difference 5.9 (95% CI 0.5 to 11.3) and 5.4 (95% CI 0.2 to 10.5), respectively) and higher levels of distress and avoidance than men who had low dose brachytherapy (5.3 (95% CI 0.2 to 10.3) and 7 (95% CI 0.5 to 13.5), respectively)29…”