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

Seaman, Aaron; Taylor, Kathryn L.; Davis, Kimberly M.; Nepple, Kenneth G.; Lynch, John H.; Oberle, Anthony D.; Hall, Ingrid J.; Volk, Robert J.; Reisinger, Heather Schacht; Hoffman, Richard M.

doi:10.1371/journal.pone.0225134

Cited by 13 publications

(32 citation statements)

References 41 publications

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“…Previous studies have identified men's understanding of the rationale behind AS as a contributing factor toward staying on AS. 21 Our findings contribute that men on AS respect the escalation of treatment invasiveness that parallels disease progression. This novel concept of treatment intensity Open access matching disease can be explored in shared decisionmaking discussions with the introduction of PGA as an intermediate option in the PCa treatment spectrum.…”

Section: Discussionmentioning

confidence: 60%

“…This finding parallels other studies that identified men's acute perception of the low-risk category and non-immediate threat to life. 13 21 However, some men in our study expressed a significant discomfort with the uncertainty of their diagnosis and were considering other treatment options. This uncertainty has been observed by others and shown to be associated with lower quality of life.…”

Section: Discussionmentioning

confidence: 83%

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Perceptions of partial gland ablation for prostate cancer among men on active surveillance: a qualitative study

Hur

Tzeng

Cricco-Lizza

et al. 2021

BMJ Surg Interv Health Technologies

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ObjectivesPartial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy-proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).Design92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semistructured telephone interviews on PGA.SettingSingle tertiary care center located in New York City.Participants20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.Main outcome measuresEmerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.ResultsFour themes were derived from 20 interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while nine men (45%) expressed interest at the current moment.ConclusionsAlthough an emerging treatment modality, patients were broadly accepting of PGA for PCa, with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men’s preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 83%

Perceptions of partial gland ablation for prostate cancer among men on active surveillance: a qualitative study

Hur

Tzeng

Cricco-Lizza

et al. 2021

BMJ Surg Interv Health Technologies

View full text Add to dashboard Cite

show abstract

“…Previous studies have identified men’s understanding of the rationale behind AS as a contributing factor towards staying on AS. [14] Our findings contribute that men on AS respect the escalation of treatment invasiveness that parallels disease progression. This novel concept of treatment intensity matching disease can be explored in shared decision-making discussions with the introduction of PGA as an intermediate option on the prostate cancer treatment spectrum.…”

Section: Discussionmentioning

confidence: 75%

“…This finding parallels of other studies that identified men’s acute perception of the low-risk category and non-immediate threat to life. [10,14] However, some men in our study expressed a significant discomfort with the uncertainty of their diagnosis and were considering other treatment options. This uncertainty has been observed by others and shown to be associated with lower quality of life.…”

Section: Discussionmentioning

confidence: 91%

Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study

Hur

Tzeng

Cricco-Lizza

et al. 2020

Preprint

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Objectives - Partial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS). Design - 92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semi-structured telephone interviews on PGA. Setting - Single tertiary care center located in New York City. Participants - 20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews. Main outcome measures - Emerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology. Results - Four themes were derived from twenty interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while 9 men (45%) expressed interest at the current moment. Conclusions - Though an emerging treatment modality, patients were broadly accepting of PGA for PCa with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men's preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

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“…The preference for GG nomenclature observed in our study is in line with qualitative work performed by Loeb et al, who demonstrated that, in a group of 25 patients with prostate cancer, 88% preferred being a 1 on a scale of 1 out of 5 rather than a 6 in the Gleason scoring system 18 . Seaman et al also demonstrated that the decision to pursue active surveillance is often a matter of the patient correctly identifying that the prognosis of the disease is favorable based on clinical factors such as prostate‐specific antigen level, Gleason score, and magnetic resonance imaging results as well as being comprehensively educated on the risks, benefits, and alternatives to active treatment 19 . Epstein and colleagues have suggested that use of the GG nomenclature can simplify a layperson's understanding of the disease pathology and more concretely convey the low aggressiveness and metastatic potential of indolent prostate cancer 20 .…”

Section: Discussionmentioning

confidence: 99%

It's all in the name: Does nomenclature for indolent prostate cancer impact management and anxiety?

Hudnall

Desai

Tsai

et al. 2021

Cancer

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Background Despite consensus guidelines, many men with low‐grade prostate cancer are not managed with active surveillance. Patient perception of the nomenclature used to describe low‐grade prostate cancers may partly explain this discrepancy. Methods A randomized online survey was administered to men without a history of prostate cancer, presenting a hypothetical clinical scenario in which they are given a new diagnosis of low‐grade prostate cancer. The authors determined whether diagnosis nomenclature was associated with management preference and diagnosis‐related anxiety using ratings given on a scale from 1 to 100, adjusting for participant characteristics through multivariable linear regression. Results The survey was completed by 718 men. Compared with Gleason 6 out of 10 prostate cancer, the term grade group 1 out of 5 prostate cancer was associated with lower preference for immediate treatment versus active surveillance (β = −9.3; 95% CI, −14.4, −4.2; P < .001), lower diagnosis‐related anxiety (β = −8.3; 95% CI, −12.8, −3.8; P < .001), and lower perceived disease severity (β = −12.3; 95% CI, −16.5, −8.1; P < .001) at the time of initial diagnosis. Differences decreased as participants received more disease‐specific education. Indolent lesion of epithelial origin, a suggested alternative term for indolent tumors, was not associated with differences in anxiety or preference for active surveillance. Conclusions Within a hypothetical clinical scenario, nomenclature for low‐grade prostate cancer affects initial perception of the disease and may alter subsequent decision making, including preference for active surveillance. Disease‐specific education reduces the differential impact of nomenclature use, reaffirming the importance of comprehensive counseling and clear communication between the clinician and patient.

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

Cited by 13 publications

References 41 publications

Perceptions of partial gland ablation for prostate cancer among men on active surveillance: a qualitative study

Perceptions of partial gland ablation for prostate cancer among men on active surveillance: a qualitative study

Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study

It's all in the name: Does nomenclature for indolent prostate cancer impact management and anxiety?

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