Page 123 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

WW. One open-ended interview of 102 men with localized disease reported that one of the
reasons for not electing WW was that their families were against that option (4 percent). Other
reasons cited were fear of consequences for not selecting WW (64 percent) and perceived
elevated risk because of increased PSA or Gleason score (12 percent). 187

Adherence to AS. No study or survey specifically addressed how family involvement might
affect adherence to AS.

Personal Preferences
Offer of AS. No study or survey specifically addressed how personal preferences might affect
the offer of AS.

Acceptance of AS. One analysis of the ProtecT trial compared 180 men who refused
randomization, but instead selected AS (i.e., men who did not participate in the trial) with 138
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men in the trial who were randomized to AS. The analysis found that men with increased
baseline anxiety (per unit increase on the Hospital Anxiety and Depression scale; adjusted OR
0.93; 95 percent CI 0.87, 0.99; P = 0.04) and lower SES (per decrease in SES from I [high] to V
[low]; adjusted OR 0.68; 95 percent CI 0.49, 0.96; P = 0.03) had decreased probability of
selecting AS and refusing randomization (i.e., these men did not proactively seek AS but
preferred randomization for AS vs. active treatment).
Four survey/interview type studies (sample size 25, 183 50, 189 185, 122 and 768 195 ) reported that
concern for treatment side effects (impotence [44 percent] and incontinence [48 percent]; 122 side
effects (11 percent, type not specified); 195 no quantitative data were available in two
studies 183,189 ) was one reason that patients elected AS/WW.
Some other reasons cited in an interview of 21 men with localized disease two of whom
chose WW were to maintain current quality of life and no need for active therapy because cancer
was small and slow-growing. 196 The authors further observed that “for most men [including both
who chose WW and those who did not], both black and white, treatment decision making
occurred within an emotional context of fear and uncertainty and without systematic use of
information.”
One multivariable analysis reported that the desire to avoid side effects or having current
bowel problems were predictive of the choice of WW versus other treatments or undecided. 178
One multivariable analysis reported that having urinary dysfunction was predictive of choosing
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WW over RP, while having sexual dysfunction was predictive of choosing RT over WW.
Another multivariable analysis reported that having other urinary conditions (besides the primary
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urinary dysfunction) was also predictive of choosing WW over RP.

Adherence to AS. One multivariable analysis reported that increased anxiety in men was
associated with an increased probability of interruption of AS. 164

Risk Perceptions
Offer of AS. No study or survey specifically addressed how risk perceptions might affect the
offer of AS.

Acceptance of AS. One qualitative description of interviews conducted in 25 men with low-risk
prostate cancer reported that physician description of prostate cancer affects patient perception of

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