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Prostate cancer survivors who would be eligible for active surveillance but were either treated with radiotherapy or managed expectantly

Men diagnosed with low-risk localised prostate cancer often face the difficulty of choosing an appropriate treatment. Localised prostate cancer treatment can curatively or managed expectantly with watchful waiting or active surveillance (AS). The often indolent nature of localised prostate cancer suggests that patients are being overtreated with curative treatment, and its associated complications could impair health-related quality of life (HRQL). However, recommending active surveillance is controversial as patients have to live with untreated cancer and undergo repeated PSA testing and biopsies, which in turn could elevate stress and anxiety levels. There is little information on the long-term quality of life and psychological morbidity of patients managed expectantly with active surveillance.

We found that besides having comparable HRQL, AS patients had better bowel and sexual functions than those having radiation therapy treatment (RT). AS patients had comparable levels of anxiety and depression as those treated with RT. The HRQL of AS patients was also comparable to an age- and sex-matched Dutch normative population. Contrary to the assumption that RT could reduce or eradicate disease progression (DP), we found that both groups had similar numbers of DP. The HRQL and symptom burden of both groups remained unchanged even when patients with DP were excluded from the analysis.

Although this cross-sectional study is limited by possible survival bias, selection bias and is non-generalizable to other types of curative treatments, nevertheless our results are unique as they provide information on the long-term effects of expectant management on HRQL and symptom management. It could be suggested that it is not the treatment per se that increases psychological morbidity but rather patients’ psychological state that determines prostate cancer treatment options. Therefore, men newly diagnosed with low-risk prostate cancer, besides receiving adequate and relevant information on the natural history of low-risk prostate cancer, could also benefit from psychological support with their decision-making.

Written by:
Melissa Thong, PhD, et al. as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

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Prostate cancer survivors who would be eligible for active surveillance but were either treated with radiotherapy or managed expectantly

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