Quality of Life in Men Undergoing Active Surveillance for Localized Prostate Cancer

Bergman, Jonathan; Litwin, Mark S.

doi:10.1093/jncimonographs/lgs026

Cited by 41 publications

(30 citation statements)

References 115 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although several studies have examined the effects of different PCa treatment modalities on HRQoL outcomes, few have prospectively compared RP versus AS or watchful waiting (WW). 20,21 A randomized clinical trial of patients who either underwent RP or received WW indicated that the prevalence of erectile dysfunction and urinary incontinence was higher in the RP cohort. 21 In another prospective study, patients who underwent RP had worse urinary and erectile function and urinary continence than those who were managed with WW after 1 year.…”

Section: Discussionmentioning

confidence: 99%

Prospective quality‐of‐life outcomes for low‐risk prostate cancer: Active surveillance versus radical prostatectomy

Jeldres

Cullen

Hurwitz

et al. 2015

Cancer

View full text Add to dashboard Cite

Background For low-risk prostate cancer (PCa), active surveillance (AS) may confer comparable oncological outcomes to radical prostatectomy (RP). Health-related quality of life (HRQoL) outcomes are important to consider, yet few studies have examined HRQoL for patients managed with AS. This study compared longitudinal HRQoL in a prospective, racially diverse, and contemporary cohort of patients who underwent RP or AS for low-risk PCa. Methods Beginning in 2007, HRQoL data from validated questionnaires (EPIC and SF-36) were collected by the Center for Prostate Disease Research in a multi-center national database. Patients aged ≤75 that were diagnosed with low-risk PCa and elected RP or AS for initial disease management were followed for three years. Mean scores were estimated using generalized estimating equations, adjusting for baseline HRQoL, demographic and clinical patient characteristics. Results Of the patients with low-risk PCa, 228 underwent RP and 77 underwent AS. Multivariable analysis revealed that RP patients had significantly worse sexual function, sexual bother, and urinary function at all time points compared to patients on AS. Differences in mental health between groups were below the threshold for clinical significance at one year. Conclusions This study found no differences in mental health outcomes but worse urinary and sexual HRQoL for RP patients compared to AS patients for up to three years. These data offer support for management of low risk PCa with AS as a means for postponing the morbidity associated with RP without concomitant mental health declines.

show abstract

Section: Discussionmentioning

confidence: 99%

Prospective quality‐of‐life outcomes for low‐risk prostate cancer: Active surveillance versus radical prostatectomy

Jeldres

Cullen

Hurwitz

et al. 2015

Cancer

View full text Add to dashboard Cite

show abstract

“…Similarly, watchful waiting may also be appropriate for patients who have low‐risk to intermediate‐risk disease and limited life expectancy . These deferred treatment strategies are generally well tolerated but may cause increased anxiety and decreased health‐related quality of life in some patients …”

Section: Introductionmentioning

confidence: 99%

“…10 These deferred treatment strategies are generally well tolerated but may cause increased anxiety and decreased health-related quality of life in some patients. 10,[14][15][16] In an effort to improve the efficacy/morbidity profile, surgical innovation has focused on evolving laparoscopic and robotic techniques. Similarly, innovation in radiotherapy has focused on delivering higher doses of radiation to more tightly defined anatomic regions through 3-dimensional conformal radiation therapy, intensity-modulated radiation therapy, low-dose-rate and high-dose-rate brachytherapy, and stereotactic radiosurgery, with or without androgen-deprivation therapy.…”

Section: Introductionmentioning

confidence: 99%

Decision aids for localized prostate cancer treatment choice: Systematic review and meta‐analysis

Violette

Agoritsas

Alexander

et al. 2015

CA A Cancer J Clinicians

119

145

View full text Add to dashboard Cite

Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making.

show abstract

“…Anxiety due to lack of access to treatment is a consistent cause of treatment withdrawal among these patients, and can negatively impact quality of life 1–3. These psychological issues can become quite prominent over many years, compared to men treated for prostate cancer 4. Surgery, radiation, and off-label use of conventional therapy such as luteinizing hormone-releasing hormone (LHRH) are viable options, but not always realistic or practical.…”

Section: Introductionmentioning

confidence: 99%

Short-term enzalutamide treatment for the potential remission of active surveillance or intermediate-risk prostate cancer: a case study, review, and the need for a clinical trial

Moyad

Scholz

2014

RRU

View full text Add to dashboard Cite

Active surveillance (AS) is a widely recognized and utilized option by which prostate cancer patients with less aggressive tumors on diagnosis defer immediate traditional conventional therapy (surgery, radiation) and undergo close monitoring by a physician for any clinical or pathologic changes. The juxtaposition of low- to intermediate-risk elderly patients between effective and conventional treatment with associated risks and monitoring without the opportunity for relief of anxiety and other psychological problems can be significant. Minimal and safe treatment over 6 months with the hope of eliminating the existing disease is of significant interest to prostate cancer patients. Unfortunately, dietary supplements have failed to improve and have sometimes even contributed to disease progression. In addition, the use of multiple medications is not always appropriate or safe. In this case study, we administered low doses of enzalutamide (80 mg/day–120 mg/day) in an AS patient during a 6 month period. Results showed a significant reduction in tumor size, as evidenced by magnetic resonance imaging and color Doppler, as well as a an undetectable level of prostate specific antigen during, and immediately following treatment. The use of an oral second-generation androgen-receptor signaling inhibitor was shown to be of benefit to patients unwilling to pursue AS and conventional treatment. Administration of enzalutamide did not reduce testosterone levels, but helped maintain good quality of life, was more cost effective at low doses, and was previously shown to be heart healthy and efficacious during early stages of castration-resistant prostate cancer. Although we do not advocate enzalutamide as a treatment approach in these situations, we believe that a clinical trial to evaluate short-term low-dose treatment using enzalutamide is warranted.

show abstract

Quality of Life in Men Undergoing Active Surveillance for Localized Prostate Cancer

Cited by 41 publications

References 115 publications

Prospective quality‐of‐life outcomes for low‐risk prostate cancer: Active surveillance versus radical prostatectomy

Prospective quality‐of‐life outcomes for low‐risk prostate cancer: Active surveillance versus radical prostatectomy

Decision aids for localized prostate cancer treatment choice: Systematic review and meta‐analysis

Short-term enzalutamide treatment for the potential remission of active surveillance or intermediate-risk prostate cancer: a case study, review, and the need for a clinical trial

Contact Info

Product

Resources

About