Page 28 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

PSA ratio, or more rapid PSA increase, but not comorbidities or Gleason score; two of four
studies found an association with younger age and one of three with higher D’Amico risk score.

Family Involvement
In two surveys, advice from family and friends was the most influential factor in deciding
treatment in 19 and 9 percent of men surveyed. In a focus group, half the men reported relying
on influential others to make a treatment decision (either for or against observational
management strategies). In an open-ended interview of men with localized disease, 4 percent
reported that family opinions were a reason for not choosing observational management
strategies.

Personal Preferences

One analysis compared men who refused randomization, but instead selected AS (i.e., men
who did not participate in the trial), to men in the trial who were randomized to AS. It found that
lower baseline anxiety was associated with the decision to choose AS (and not be randomized).
Four surveys found that concern for treatment side effects (primarily impotence and
incontinence) were reasons that men chose observational management strategies. Three
multivariable analyses found predictors of choosing observational management strategies
included the desire to avoid side effects or having current bowel problems, urinary dysfunction,
or other urinary conditions; sexual dysfunction was predictive of choosing RT over observational
management strategies. One multivariable analysis also reported that increased anxiety was
associated with an increased probability of interruption of observational management strategies.

Risk Perceptions
One set of interviews in men with low-risk prostate cancer reported that physician
description of prostate cancer affected treatment choice. One survey of men with early stage
prostate cancer reported that men who chose RP over RT or observational management strategies
perceived prostate cancer as a significantly more serious disease. Another survey of men with
localized prostate cancer reported that fear of consequences was the most common reason for not
selecting observational management strategies.

Family History

Two multivariable analyses reported that family history was not a significant factor in
predicting interruption of observational management strategies.

Social Support
Four multivariable analyses reported that not being married or in a permanent relationship
were associated with an increased probability of receiving observational management strategies.
One survey of couples in which the men were diagnosed with early-stage cancer but had not yet
decided on treatment 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.”
One multivariable analysis reported that marital status was not associated with time to
interruption of observational management strategies.

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