Patient Perspective on Watchful Waiting/Active Surveillance for Localized Prostate Cancer

Abstract

Objective To describe prostate cancer treatment decision making, focusing on knowledge and attitudes toward observation, known as watchful waiting (WW) or active surveillance (AS), and reasons for not choosing WW/AS. Methods Semistructured in-person interviews were conducted with 21 men (14 black; 7 white) with recently diagnosed localized prostate cancer. Results All cancers were detected by prostate-specific antigen screening; 14 men had low-risk disease. Nineteen chose surgery or radiation treatment. The majority wanted to “get rid of” or “cure” the cancer by undergoing aggressive therapy, even with awareness of the potential for significant side effects. Most men seemed unaware of the uncertainty/controversies that aggressive treatment may not cure their cancer or improve their survival. Limited knowledge about WW/AS was common, and few remembered WW/AS being presented as a viable option. Rather, many men perceived it as “doing nothing.” Some men, who initially were inclined toward WW/AS, yielded to pressure from family, physicians, or both to choose aggressive treatment. Lack of physician support was a significant barrier to WW/AS. Conclusions The observational strategy (WW/AS) was not viewed as a reasonable approach, even for those with low-risk cancer. The desire for aggressive therapy may reflect the complex psychology associated with receiving a diagnosis of cancer and the limited supportive counseling received. Further efforts to better understand and educate patients and physicians may help men make informed and appropriate treatment decisions to maximize quality of life without compromising survival.

Patient Knowledge and Qualities of Treatment Decisions for Localized Prostate Cancer

“…We think this result is plausible since so many controversies and uncertainties exist surrounding the myriad treatment options for LPC and a lack of consensus even among experts regarding the best decision. 9,10,13 Another possible explanation is that when men's overall knowledge of treatment side effects and survival benefit is so low, it may not reach the threshold at which a positive impact on decisionmaking difficulty can be observed. In fact, Orom et al 12 also reported that increased knowledge of LPC was associated with greater decision-making difficulty.…”

“…Since no validated knowledge scale about LPC is available in the literature, we constructed our own knowledge scale based on the literature and qualitative studies. 9,10,32 Finally, our data were from 1 geographic location that may not be representative of other locations.…”

“…Since we could not find a published validated LPC knowledge scale, we developed our own based on a through review of the literature and qualitative studies. 9,10 The knowledge scale consisted of 11 statements about the natural history of LPC and its treatment options (eg, comparative side effect profiles, facts and myths) using the options "true," "false," or "do not know" (Table 1). Each correct answer was scored with 1 point, and the total knowledge score was the sum of all correct answers.…”

Enhancing Knowledge, Beliefs, and Intention to Screen for Prostate Cancer via Different Health Educational Interventions: a Literature Review

“…Furthermore, in a recent study among Indian patients Xu et al (2012) indicated that most men were unaware of treatment options and the outcomes for prostate cancer.…”

Patients Survival Expectations With and Without Their Chosen Treatment for Prostate Cancer

“…8,16 The survey asked men to report their treatment choice, reasons for the choice, and what treatment options were offered and recommended by their physicians. 5 In addition, patients were asked the following 2 questions: "How long do you expect you would live without any treatment for your prostate cancer?"…”