Patients' perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy

Abstract

Treatment choice for localized prostate cancer (PCa) is a controversial issue, and mortality risk is probably the most decisive factor in this regard. The study aimed to compare prostate-cancer-specific mortality risk estimates for different treatment options assigned by patients managed with active surveillance (AS), radical prostatectomy (RP) and patients who had discontinued AS (DAS). Patients initially managed with AS or RP (N 5 370) were matched according to length of therapy. All patients completed mailed questionnaires assessing their mortality risk estimates (in %) and prostate-cancer-specific anxiety. Differences in risk estimates among the three treatment groups were analyzed using ANOVA, relationships of clinical and psychosocial variables with risk estimates using standard multiple regression. In all treatment groups, the prostate-cancer-specific mortality risk was overestimated. This applied whether it was the patient's own treatment or the alternative treatment option. RP patients assigned a mortality risk to AS that was almost three times higher than that assigned to RP (50.9 6 25.0 vs. 17.8 6 19.7, d 5 1.48; p < 0.001). Anxiety was significantly associated with risk estimates for AS (p 5 0.008) and RP (p 5 0.001). Compared with clinical data that suggest that the prostate-cancer-specific mortality risk for AS is low and does not significantly differ from that for RP, patients strongly overestimated the mortality risk. This was most markedly so in RP patients, who drastically overestimated the benefits of RP compared to the risk of AS. This overestimation could increase overtreatment and should therefore be corrected by better patient education.

The accuracy of patients’ perceptions of the risks associated with localised prostate cancer treatments

“…To our knowledge, the present study is the first to investigate patients’ perceptions of the risks of adverse outcomes after prostate cancer treatment prior to their receiving treatment. Consistent with previous qualitative studies, our present results indicate that most patients’ risk perceptions’ deviate from risk outcomes reported in the literature .…”

“…Another strength of the present study is the method used to assess the patients’ risk perceptions and misperceptions (quantitatively assessing perceived risks per treatment option). Therefore, the clinical utility of the present study is elevated compared to previous studies that, mostly qualitatively, assessed less specific constructs like ‘prostate cancer knowledge’ (containing a variety of prostate cancer‐related concepts) . The detailed information about what exact risks are often misperceived by patients, and factors contributing to more accurate perceptions, provide concrete and practical information for developers of interventions (e.g.…”

“…However, when involving patients in decision making, it is important that they have an accurate understanding of the differences amongst the treatment options . Several qualitative studies have suggested that patients’ treatment preferences are frequently based on misperceptions rather than on accurate information . To our knowledge, no quantitative studies have investigated the extent to which patients with prostate cancer have an accurate understanding of the risk of adverse outcomes for the various treatment options .…”

Risk stratification: a tool to predict the course of active surveillance for localized prostate cancer?

“…While this finding could partly be attributable to the small number of patients or to the patient′s greater freedom of choice based on the HAROW study's specific design, it may also indicate that patients with higher‐risk features have a greater fear of tumour progression. The latter could be explained by the observation that patients undergoing AS tend to strongly overestimate their mortality risk .…”

Health‐related quality of life in active surveillance and radical prostatectomy for low‐risk prostate cancer: a prospective observational study (HAROW ‐ Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting)

“…The statistically significantly lower baseline measure in emotional functioning for RP might be due to the patients knowing that they will undergo surgery and thus are more psychologically stressed and anxious. On the other hand, higher levels of distress when facing a cancer diagnosis might lead to a more radical treatment decision . The RP patients’ clinically significantly lower baseline measure of social functioning, with a further decline up to 6 months after diagnosis might again be explained by patients’ tendency towards a surgical treatment option, when social functioning is substantially impaired by the diagnosis.…”