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PLoS One. 2019 Nov 20;14(11):e0225134. doi: 10.1371/journal.pone.0225134. eCollection 2019.

Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study.

Author information

1
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America.
2
Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America.
3
Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America.
4
Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States of America.
5
Department of Urology, Georgetown University, Washington, DC, United States of America.
6
Prostate Cancer Center, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America.
7
Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
8
Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.

Abstract

OBJECTIVE:

Active surveillance (AS) is an increasingly utilized strategy for monitoring men with low-risk prostate cancer (PCa) that allows them to defer active treatment (AT) in the absence of cancer progression. Studies have explored reasons for selecting AS and for then switching to AT, but less is known about men's experiences being on AS. We interviewed men to determine the clinical and psychological factors associated with selecting and adhering to AS protocols.

METHODS:

We conducted semi-structured interviews with men with a low-risk PCa at two academic medical centers. Subjects had either been on AS for ≥ 1 year or had opted for AT after a period of AS. We used an iterative, content-driven approach to analyze the interviews and to identify themes.

RESULTS:

We enrolled 21 subjects, mean age 70.4 years, 3 racial/ethnic minorities, and 16 still on AS. Men recognized the favorable prognosis of their cancer (some had sought second opinions when initially offered AT), valued avoiding treatment complications, were reassured that close monitoring would identify progression early enough to be successfully treated, and trusted their urologists. Although men reported feeling anxious around the time of surveillance testing, those who switched to AT did so based only on evidence of cancer progression.

CONCLUSIONS:

Our selected sample was comfortable being on AS because they understood and valued the rationale for this approach. However, this highlights the importance of ensuring that men newly diagnosed with a low-risk PCa are provided sufficient information about prognosis and treatment options to make informed decisions.

PMID:
31747396
DOI:
10.1371/journal.pone.0225134
Free PMC Article

Conflict of interest statement

The authors have declared that no competing interests exist.

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