Page 124 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

the seriousness of the condition as well as treatment choice. 183 One survey of 654 men with early
stage prostate cancer reported that men who chose RP over RT or WW perceived prostate cancer
as a significantly more serious disease. 185 Another survey of 102 men with localized prostate
cancer reported that fear of consequences was the most common reason for not selecting WW. 187

Adherence to AS. No study or survey specifically addressed how risk perceptions might affect
the adherence to AS.

Family History
Offer of AS. No study or survey specifically addressed how family history might affect the offer
of AS.

Acceptance of AS. No study or survey specifically addressed how family history might affect
the acceptance of AS.

Adherence to AS. Two multivariable analyses reported that family history was not a significant
factor in predicting interruption of AS/WW. 175,176

Social Support
Offer of AS. No study or survey specifically addressed how social support might affect the offer
of AS.

Acceptance of AS. Four multivariable analyses reported that not being married or in a
permanent relationship was associated with an increased probability of receiving WW versus
active treatments. 77,160,166,180 One analysis found that marital status was not a factor in predicting
receiving WW. 177
A report of interviews with 18 couples in which the men were recently diagnosed with early
stage prostate cancer and had not yet decided on a treatment demonstrated the complexity of
reaching a treatment decision. 194 The authors concluded that couples ruled out options based on
both formal (provided by the physicians) and informal (provided by family and friends)
information, and that they also “considered both their own individual histories and concerns and
their shared life experiences.” Of the 18 couples referred by urologists, only one couple elected
watchful waiting. The authors further stated that “’Doing nothing’ was ultimately rejected for the
certainty [the couples] perceived to be associated with it: certain death, feared to be slow and
painful.”

Acceptance of AS. One multivariable analysis reported that marital status was not associated
164
with time to interruption of AS.
Other Factors That Could Affect the Offer of, Acceptance of, or
Adherence to AS

Income or socioeconomic status. Three multivariable analyses examined income level with
respect to AS/WW. 66,177,199 One reported that less than $30,000 annual income (versus at least
$40,000) in men with prostate cancer was associated with an increased probability of receiving
199
AS/WW versus other treatments. The remaining two reported that income was not a
significant factor in predicting the choice of AS/WW versus other treatments. 66,177

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