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Alberti A, Nicoletti R, Castellani D, Yuan Y, Maggi M, Dibilio E, Resta GR, Makrides P, Sessa F, Sebastianelli A, Serni S, Gacci M, De Nunzio C, Teoh JYC, Campi R. Patient-reported Outcome Measures and Experience Measures After Active Surveillance Versus Radiation Therapy Versus Radical Prostatectomy for Prostate Cancer: A Systematic Review of Prospective Comparative Studies. Eur Urol Oncol 2024:S2588-9311(24)00138-X. [PMID: 38816298 DOI: 10.1016/j.euo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Current management options for localized prostate cancer (PCa) include radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS). Despite comparable oncological outcomes, there is still lack of evidence on their comparative effectiveness in terms of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). We conducted a systematic review of studies comparing PROMs and PREMs after all recommended management options for localized PCa (RP, RT, AS). METHODS A literature search was performed in the MEDLINE, EMBASE, and Cochrane CENTRAL databases in accordance with recommendations from the European Association of Urology Guidelines Office and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All prospective clinical trials reporting PROMs and/or PREMs for comparisons of RP versus RT versus AS were included. A narrative synthesis was used to summarize the review findings. No quantitative synthesis was performed because of the heterogeneity and limitations of the studies available. KEY FINDINGS AND LIMITATIONS Our findings reveal that RP mostly affects urinary continence and sexual function, with better results for voiding symptoms in comparison to other treatments. RT was associated with greater impairment of bowel function and voiding symptoms. None of the treatments had a significant impact on mental or physical quality of life. Only a few studies reported PREMs, with a high rate of decision regret for all modalities (up to 23%). CONCLUSIONS AND CLINICAL IMPLICATIONS All recommended treatments for localized PCa have an impact on PROMs and PREMs, but for different domains and with differing severity. We found significant heterogeneity in PROM collection, so standardization in real-world practice and clinical trials is warranted. Only a few studies have reported PREMs, highlighting an unmet need that should be explored in future studies. PATIENT SUMMARY We reviewed differences in patient reports of their outcomes and experiences after surgical prostate removal, radiotherapy, or active surveillance for prostate cancer. We found differences in the effects on urinary, bowel, and sexual functions among the treatments, but no difference for mental or physical quality of life. Our results can help doctors and prostate cancer patients in shared decision-making.
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Affiliation(s)
- Andrea Alberti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Rossella Nicoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Rome, Italy
| | - Edoardo Dibilio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Giulio Raffaele Resta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Pantelis Makrides
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Mauro Gacci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
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Venderbos LDF, Remmers S, Deschamps A, Dowling J, Carl EG, Pereira-Azevedo N, Roobol MJ. The Europa Uomo Patient Reported Outcome Study 2.0-Prostate Cancer Patient-reported Outcomes to Support Treatment Decision-making. Eur Urol Focus 2023; 9:1024-1036. [PMID: 37268512 DOI: 10.1016/j.euf.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND To further strengthen the voice of patients, Europa Uomo initiated the Europa Uomo Patient Reported Outcome Study 2.0 (EUPROMS 2.0) in October 2021. OBJECTIVE To collect the self-reported perspective of prostate cancer (PCa) patients on physical and mental well-being after PCa treatment outside a clinical trial setting to inform future fellow patients about the impact of PCa treatment. DESIGN, SETTING, AND PARTICIPANTS Europa Uomo invited PCa patients to complete a cross-sectional survey including the validated EQ-5D-5L, EORTC-QLQ-C30, and the EPIC-26 questionnaires. Furthermore, the nine-item Shared Decision Making Questionnaire (SDM-Q-9) and diagnostic clinical scenarios were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics was used to assess the demographic and clinical characteristics and to analyze the patient-reported outcome data. RESULTS AND LIMITATIONS Between October 25, 2021 and January 17, 2022, 3571 men from 30 countries completed the EUPROMS 2.0 survey. The median age of respondents was 70 yr (interquartile range 65-75 yr). Half of the respondents underwent one treatment, most often radical prostatectomy. Men who are treated actively experience lower health-related quality of life than men on active surveillance, mainly regarding sexual function, fatigue, and insomnia. Lower urinary incontinence levels were seen for men who underwent radical prostatectomy (single treatment or in combination with other treatments). Of the respondents, 42% indicated that the determination of the prostate-specific antigen (PSA) value was part of a routine blood test; 25% wanted to undergo screening/early detection for PCa, and 20% indicated that the determination of the PSA value had a clinical reason. CONCLUSIONS A large sample of 3571 international patients has contributed patient experience after PCa treatment in the EUPROMS 2.0 study, confirming that treatment for PCa mainly affects urinary incontinence, sexual function, fatigue, and insomnia. Such information can be used to direct toward a better patient-doctor relationship, to offer patients ready access to responsible information and a better understanding of their disease and treatment. PATIENT SUMMARY Through the EUPROMS 2.0 survey, Europa Uomo has strengthened the voice of the patient. Such information can be used to inform future prostate cancer (PCa) patients about the impact of PCa treatment and to engage them in informed and shared decision-making.
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Affiliation(s)
- Lionne D F Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Nuno Pereira-Azevedo
- Department of Urology, Entre o Douro e Vouga Medical Center, Santa Maria da Feira, Portugal
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Remmers S, Nieboer D, Roobol MJ. The Patient Journey from Randomization to Detection of Prostate Cancer and Death: Results from ERSPC Rotterdam. EUR UROL SUPPL 2023; 51:1-6. [PMID: 37187725 PMCID: PMC10175721 DOI: 10.1016/j.euros.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 05/17/2023] Open
Abstract
Background The ERSPC study has demonstrated that prostate-specific antigen (PSA)-based screening results in a relative increase in diagnosis of (low-risk) prostate cancer (PCa) and a reduction in metastatic disease and PCa mortality. Objective To evaluate the burden of PCa among men randomized to active screening compared to those in the control arm in ERSPC Rotterdam. Design setting and participants We analyzed data for participants in the Dutch section of the ERSPC, including 21 169 men randomized to the screening arm and 21 136 randomized to the control arm. Men in the screening arm were invited for PSA-based screening every 4 yr, and transrectal ultrasound-guided prostate biopsy was recommended for those with PSA ≥3.0 ng/ml. Outcome measurements and statistical analysis We analyzed detailed follow-up and mortality data up to January 1, 2019, to a maximum of 21 yr, using multistate models. Results and limitations At 21 yr, 3046 men (14%) had been diagnosed with nonmetastatic PCa and 161 (0.76%) with metastatic PCa in the screening arm. In the control arm, 1698 men (8.0%) had been diagnosed with nonmetastatic PCa and 346 (1.6%) with metastatic PCa. In comparison to the control arm, men in the screening arm were diagnosed with PCa almost 1 yr earlier and if diagnosed with nonmetastatic PCa lived on average for almost 1 yr longer without disease progression. Among those who experienced biochemical recurrence (18-19% after nonmetastatic PCa), progression to metastatic disease or death was quicker in the control arm: men in the screening arm lived for 7.17 yr without progression, while the progression-free interval was only 1.59 yr for men in the control arm over a 10-yr time period. Among those who experienced metastatic disease, men in both study arms lived for 5 yr over a 10-yr time period. Conclusions PCa diagnosis was earlier after study entry for men in the PSA-based screening arm. However, disease progression was not as fast in the screening arm as in the control arm: once men in the control arm experienced biochemical recurrence, progression to metastatic disease or death was 5.6 yr faster than in the screening arm. Our results confirm the ability of early disease detection to reduce suffering and death from PCa at the cost of earlier (and more frequent) treatment-induced reductions in quality of life. Patient summary Our study shows that early detection of prostate cancer can reduce suffering and death from this disease. However, screening based on measurement of prostate-specific antigen (PSA) can also result in an earlier treatment-induced reduction in quality of life.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Corresponding author. Department of Urology, Erasmus University Medical Center, P.O. Box 2040, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel. +31 10 7032 239; Fax: +31 10 7035 315.
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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Thompson D, Bensley JG, Tempo J, Ehdaie B, Carlsson S, Eastham J, Bolton D, Perera M, Papa N. Long-term Health-related Quality of Life in Patients on Active Surveillance for Prostate Cancer: A Systematic Review. Eur Urol Oncol 2023; 6:4-15. [PMID: 36156268 PMCID: PMC9908828 DOI: 10.1016/j.euo.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT Active surveillance (AS) represents the preferred treatment option in patients with low-risk prostate cancer. Optimised patient selection has enabled more patients to be managed with AS for a longer time. Thus, there is growing interest in its effect on long-term quality of life compared with interventional management. OBJECTIVE To perform a systematic review evaluating the long-term patient-reported outcomes regarding mental health, and sexual and urinary function in patients on AS. EVIDENCE ACQUISITION We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We included series assessing validated patient-reported outcomes of health-related quality of life, and sexual and urinary function in AS patients followed up for at least 5 yr. EVIDENCE SYNTHESIS Our search yielded 1854 citations, including 19 papers involving 3643 patients on AS, 14 651 patients receiving surgery or radiotherapy, and 2478 controls without prostate cancer. In ten studies, major differences were observed in sexual and urinary symptoms between groups, such as better sexual function and fewer irritative urinary symptoms in patients on AS, though overall functional outcomes were comparable. In all studies, health-related quality of life for patients on AS was better than, or similar to, that for patients who had undergone surgery or radiotherapy and comparable with that for individuals without cancer. CONCLUSIONS We observed differences in specific functional outcomes between patients on AS and surgery or radiotherapy, ≥5 yr after treatment. Patients on AS reported good quality of life, similar to that in individuals without prostate cancer. AS should continue to be a recommended management strategy for appropriately selected patients. PATIENT SUMMARY Active surveillance is an accepted pathway for patients with low-risk localised prostate cancer. Previous literature has shown that it did not negatively affect short-term quality of life. This review finds that long-term quality of life for these patients is similar to that for people without prostate cancer.
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Affiliation(s)
- Daryl Thompson
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia
| | - Jonathan G Bensley
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jake Tempo
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Bratt O, Carlsson S, Fransson P, Thellenberg Karlsson C, Stranne J, Kindblom J. The Swedish national guidelines on prostate cancer, part 1: early detection, diagnostics, staging, patient support and primary management of non-metastatic disease. Scand J Urol 2022; 56:265-273. [PMID: 35811480 DOI: 10.1080/21681805.2022.2094462] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on. METHODS This is part 1 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. It covers the early detection, diagnostics, staging, patient support and management of the non-metastatic disease. Part 2 covers recurrence after local treatment and management of the metastatic disease. RESULTS The 2022 Swedish guidelines include several new recommendations: rectal iodine-povidone to reduce post-biopsy infections, external beam radiation with focal boost to the tumour, use of a pre-rectal spacer to reduce rectal side effects after external beam radiotherapy in some expert centres, 6 months' concomitant and adjuvant rather than neoadjuvant and concomitant hormonal treatment together with radiotherapy for unfavourable intermediate and high-risk disease, and adjuvant abiraterone plus prednisolone together with a GnRH agonist for a subgroup of men with very high-risk disease. The Swedish guidelines differ from the European by having more restrictive recommendations regarding genetic testing and pelvic lymph node dissection, the risk group classification, recommending ultra-hypofractionated (7 fractions) external radiotherapy for intermediate and selected high-risk cancers, by not recommending any hormonal treatment together with radiotherapy for favourable intermediate-risk disease, and by recommending bicalutamide monotherapy instead of a GnRH agonist for some patient groups. CONCLUSIONS The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.
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Affiliation(s)
- Ola Bratt
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Göteborg, Sweden
| | - Stefan Carlsson
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Johan Stranne
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Göteborg, Sweden
| | - Jon Kindblom
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
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Sugimoto M, Kakehi Y, Horie S, Hirao Y, Akaza H. A randomized controlled trial evaluating the effect of low-dose chlormadinone in patients with low-risk prostate cancer: PROSAS study. Jpn J Clin Oncol 2021; 52:187-196. [PMID: 34698353 PMCID: PMC8825478 DOI: 10.1093/jjco/hyab162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study was conducted to evaluate the effect of low-dose chlormadinone acetate, an antiandrogen agent, on the persistence rate of active surveillance in patients with low-risk prostate cancer. METHODS The study was a multicenter, placebo-controlled, double-blind, randomized controlled trial conducted at 38 sites in Japan. Low-risk prostate cancer patients were randomly assigned to the chlormadinone group or the placebo group and the persistence rate of active surveillance was evaluated for 3 years. RESULTS Seventy-one patients in the chlormadinone group and 72 patients in the placebo group were analyzed. The persistence rate of active surveillance [95% CI] at 3 years was 75.5% [62.5-84.6] in the chlormadinone group and 50.1% [36.7-62.2] in the placebo group, showing a significant difference between the groups (P = 0.0039). The hazard ratio [95% CI] of the chlormadinone group to the placebo group for discontinuation of active surveillance was 0.417 [0.226-0.770]. The chlormadinone group showed a significant decrease in prostate specific antigen level, testosterone level and prostate volume. The number of positive cores at 12 and 36 months biopsy was significantly lower in the chlormadinone group. The incidence of adverse events was 43.7% in the chlormadinone group and 12.5% in the placebo group. The most common adverse event in the chlormadinone group was constipation in 22.5%, followed by hepatobiliary disorders in 9.9%. CONCLUSIONS In patients with low-risk prostate cancer, low-dose chlormadinone showed a reduced number of positive cores and prostate volume, and an increased persistence rate of active surveillance (UMIN000012284).
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Affiliation(s)
- Mikio Sugimoto
- Department of Urology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | | | - Shigeo Horie
- Department of Urology, Juntendo University Faculty of Medicin, Tokyo, Japan
| | | | - Hideyuki Akaza
- Interfaculty Initiative in Information Studies, Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
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Zhen L, Zhien Z, Shengmin Y, Hanzhong L, Xingcheng W, Yi Z, Yi Q, Lin M, Yuliang C, Tianrui F, Weigang Y. Can patients with low-risk prostate cancer really benefit from radical treatment?: A systematic review and network meta-analysis. Andrologia 2021; 53:e14122. [PMID: 34319588 DOI: 10.1111/and.14122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/15/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022] Open
Abstract
Radical prostatectomy, radiotherapy and active surveillance are three widely used treatment options for patients with low-risk prostate cancer, but the relative effects are controversial. We searched PubMed, Embase and Web of Science until June 2020, focusing on the studies comparing the effect of radical prostatectomy, radiotherapy and active surveillance in patients with low-risk prostate cancer. Through the random-effects model, dichotomous data were extracted and summarised by odds ratio with a 95% confidence interval. Twenty-two studies containing 185,363 participants were pooled for the comprehensive comparison. The Bayesian mixed network estimate demonstrated the cancer-specific mortality of radical prostatectomy was significantly lower than active surveillance (OR, 0.46; 95% CI 0.34-0.64) and external beam radiation therapy (OR, 0.66; 95% CI 0.46-0.96), but not brachytherapy (OR, 0.63; 95% CI 0.41-1.03). The brachytherapy demonstrated the best treatment ranking probability results in terms of all-cause mortality, while no significant difference was observed when compared with other three treatment modalities. Brachytherapy and radical prostatectomy were associated with a similar risk of cancer-specific mortality, and both of them were significantly superior to active surveillance and external beam radiation therapy; nevertheless, there was no significant difference among the aforementioned treatment methods in all-cause mortality.
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Affiliation(s)
- Liang Zhen
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Zhou Zhien
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Yang Shengmin
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li Hanzhong
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Wu Xingcheng
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Zhou Yi
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Qiao Yi
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Ma Lin
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Chen Yuliang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Feng Tianrui
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
| | - Yan Weigang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, China
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Otto I, Hilger C, Magheli A, Stadler G, Kendel F. Illness representations, coping and anxiety among men with localized prostate cancer over an 18-months period: A parallel vs. level-contrast mediation approach. Psychooncology 2021; 31:227-237. [PMID: 34467601 DOI: 10.1002/pon.5798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Men diagnosed with localized prostate cancer (lPCa) are confronted with the decision for a treatment strategy, potentially experiencing treatment side effects and psychological distress. The Common Sense Model proposes that coping with such challenges is related to illness representations: Beliefs regarding consequences, coherence, timeline, and controllability of the illness. We analyzed the interplay of illness representations, coping and anxiety over an 18-month period among men with lPCa undergoing different treatment options (Active Surveillance, curative treatment). METHODS In this longitudinal study, 183 men (age M = 66.83) answered a questionnaire before starting treatment, and 6, 12, and 18 months later. We analyzed time trajectories with growth curve modeling and conducted mediation analyses to evaluate the influence of coping on the association of illness representations and anxiety. Using a novel methodological approach, we compared a classic parallel mediation model with a level-contrast approach for the correlated mediators problem- and emotion-focused coping. RESULTS Independent of treatment (b = 1.31, p = 0.200) men reported an elevated level of anxiety after diagnosis which declined considerably within the following 6 months (b = -1.87, p = 0.009). The perceived seriousness of consequences was significantly associated with greater anxiety, at baseline (β = 0.471) and over time (all β ≥ 0.204). This association was mediated by coping: Using more emotion-than problem-focused coping was associated with higher anxiety. CONCLUSIONS Receiving a lPCa diagnosis is associated with a phase of increased anxiety. In order to reduce anxiety, information provision should be accompanied by developing concrete action plans to enable problem-focused coping strategies.
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Affiliation(s)
- Isabella Otto
- Gender in Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Caren Hilger
- Gender in Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Ahmed Magheli
- Clinic for Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Gertraud Stadler
- Gender in Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Friederike Kendel
- Gender in Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
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Shill DK, Roobol MJ, Ehdaie B, Vickers AJ, Carlsson SV. Active surveillance for prostate cancer. Transl Androl Urol 2021; 10:2809-2819. [PMID: 34295763 PMCID: PMC8261451 DOI: 10.21037/tau-20-1370] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/25/2021] [Indexed: 12/20/2022] Open
Abstract
Many men diagnosed with localized prostate cancer can postpone definitive treatment without raising their risk of metastasis or death from disease. Active surveillance (AS) is a method of monitoring select men, with the option of switching to active treatment upon signs of progression, thereby avoiding the well-known side-effects of surgery and radiotherapy. This review analyzes the data from long-running AS cohorts to determine the safety and efficacy of AS. We conducted a narrative review of recently published data, including 14 articles from 13 AS cohorts. The cohorts used varying inclusion criteria, with reported differences in clinical T stage and Gleason Score (Grade Group), among other features. Some studies (n=5) limited their cohorts to low-risk patients, while others (n=8) also included intermediate-risk patients. The heterogeneity of the cohorts produced mixed results, with the risk of prostate cancer metastasis ranging from 0.1–1.0% at 10 years and the risk of prostate cancer mortality ranging from 0–1.9% at 10 years. However, the majority of studies reported risks of less than 0.5% at 10 years for both metastasis and death. For most cohorts, half of men remained untreated for 5–10 years, with estimates ranging from 37% receiving active treatment in the Toronto cohort to 73% in the Prostate Cancer Research International AS (PRIAS) study. Current data do not support the use of negative magnetic resonance imaging (MRI) to avoid scheduled biopsy. Taken together, the data collected from these AS cohorts suggests that AS is a safe approach for men with low-grade prostate cancer and some men with intermediate risk disease. AS should be more broadly implemented for eligible patients to avoid the decreases in quality of life from undergoing active treatment. Studies expanding the inclusion criteria and further defining a subset of men with favorable intermediate-risk prostate cancer who might safely benefit from AS are needed to assess the long-term outcomes of using AS in intermediate-risk groups.
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Affiliation(s)
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Behfar Ehdaie
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
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10
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Yiannopoulou KG, Anastasiou AI, Kontoangelos K, Papageorgiou C, Anastasiou IP. Cognitive and Psychological Impacts of Different Treatment Options for Prostate Cancer: A Critical Analysis. Curr Urol 2021; 14:169-177. [PMID: 33488334 DOI: 10.1159/000499242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Psychological morbidity as well as cognitive impairment are increasingly reported in prostate cancer (PCa) patients. However, despite growing numbers of PCa survivors and the well estimated negative impact of cognitive decline and emotional distress on survivors' quality of life, no study has assessed the whole range of cognitive and psychological sequelae as a response to treatment options for PCa. The objective of the present review was to systematically characterize the types and estimate the prevalence of the cognitive impairment and emotional burdens that were found in PCa survivors secondary to different treatment options. Methods Systematic, general reviews, meta-analysis, and overviews of review studies in English, that were published in PubMed during the last 10 years until l August 2019 and that reported psychological distress, anxiety, depression, cognitive decline, or dementia among individuals with PCa exposed to a particular treatment option were analyzed. Results A total of 21 articles were reviewed. Some of the studies described one or more cognitive or psychological consequences of only one therapeutic strategy while others compared the psychological impacts among different strategies. Most of these studies suggested that either radical prostatectomy or active surveillance and radiotherapy were well-tolerated treatments in terms of psychological modifications. However, many of these patients may require additional emotional support. There is also increasing evidence that androgen deprivation therapy may be associated with depression, while controversy surrounding the association between cognitive dysfunction, dementia, and androgen deprivation therapy remains ambivalent. Conclusion Emotional distress and cognitive decline may accompany every PCa treatment option to different degrees. Accurate information on the short- and long-term effect of treatments on cognitive and psychological aspects should be provided to patients during treatment decision-making. There is also a need to develop well-targeted psychological and neurological interventions that could help those experiencing ongoing post-treatment difficulties.
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Affiliation(s)
| | | | - Konstantinos Kontoangelos
- 1st Department of Psychiatry, Medical School, National & Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Charalambos Papageorgiou
- 1st Department of Psychiatry, Medical School, National & Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Ioannis P Anastasiou
- 1st Urology Department, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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11
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Schofield P, Gough K, Hyatt A, White A, Frydenberg M, Chambers S, Gordon LG, Gardiner R, Murphy DG, Cavedon L, Richards N, Murphy B, Quinn S, Juraskova I. Navigate: a study protocol for a randomised controlled trial of an online treatment decision aid for men with low-risk prostate cancer and their partners. Trials 2021; 22:49. [PMID: 33430950 PMCID: PMC7802237 DOI: 10.1186/s13063-020-04986-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Active surveillance (AS) is the disease management option of choice for low-risk prostate cancer. Despite this, men with low-risk prostate cancer (LRPC) find management decisions distressing and confusing. We developed Navigate, an online decision aid to help men and their partners make management decisions consistent with their values. The aims are to evaluate the impact of Navigate on uptake of AS; decision-making preparedness; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life and anxiety. In addition, the healthcare cost impact, cost-effectiveness and patterns of use of Navigate will be assessed. This paper describes the study protocol. METHODS Three hundred four men and their partners are randomly assigned one-to-one to Navigate or to the control arm. Randomisation is electronically generated and stratified by site. Navigate is an online decision aid that presents up-to-date, unbiased information on LRPC tailored to Australian men and their partners including each management option and potential side-effects, and an interactive values clarification exercise. Participants in the control arm will be directed to the website of Australia's peak national body for prostate cancer. Eligible patients will be men within 3 months of being diagnosed with LRPC, aged 18 years or older, and who are yet to make a treatment decision, who are deemed eligible for AS by their treating clinician and who have Internet access and sufficient English to participate. The primary outcome is self-reported uptake of AS as the first-line management option. Secondary outcomes include self-reported preparedness for decision-making; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life. Uptake of AS 1 month after consent will be determined through patient self-report. Men and their partners will complete study outcome measures before randomisation and 1, 3 and 6 months after study consent. DISCUSSION The Navigate online decision aid has the potential to increase the choice of AS in LRPC, avoiding or delaying unnecessary radical treatments and associated side effects. In addition, Navigate is likely to reduce patients' and partners' confusion and distress in management decision-making and increase their quality of life. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ACTRN12616001665426 . Registered on 2 December 2016. All items from the WHO Trial Registration Data set can be found in this manuscript.
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Affiliation(s)
- Penelope Schofield
- Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia. .,Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia. .,Swinburne University of Technology, John Street, Hawthorn, Australia.
| | - Karla Gough
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Amelia Hyatt
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan White
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Malvern, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Louisa G Gordon
- Population Health Department, Health Economics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Robert Gardiner
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lawrence Cavedon
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Natalie Richards
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Barbara Murphy
- Department of Psychology, The University of Melbourne, Parkville, Victoria, Australia.,Faculty of Health, Deakin University, Bundoora, Victoria, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, New South Wales, Australia
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12
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Dordoni P, Badenchini F, Alvisi MF, Menichetti J, De Luca L, Di Florio T, Magnani T, Marenghi C, Rancati T, Valdagni R, Bellardita L. How do prostate cancer patients navigate the active surveillance journey? A 3-year longitudinal study. Support Care Cancer 2020; 29:645-651. [PMID: 32424643 DOI: 10.1007/s00520-020-05524-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether prostate cancer (PCa) patients' coping strategies (i.e., fighting spirit, anxious preoccupation, fatalism, helplessness/hopelessness, and avoidance) significantly change during the first 3-year follow-up period of active surveillance (AS). MATERIALS AND METHODS Altogether, 104 patients on AS completed the Mini-Mental Adjustment to Cancer (Mini-MAC) at baseline (T0), at 10 and 12 months after diagnostic biopsy (T1 and T2, respectively) and then at 24- (T3) and 36-month (T4) follow-up. Paired samples T test was used to detect statistically significant changes over time. Changes ≥ 1 point (or ≤ - 1) were hypothesized to be clinically relevant. RESULTS During the first 3 years on AS, men experienced decreased anxiety, avoidance thoughts/behaviors, and fight-against-cancer attitudes, and these changes were found to be statistically significant. When considering clinically significant changes between inclusion in AS (T0) and 3-year follow-up (T4), avoidance decreased in 19% of patients. CONCLUSIONS Most patients were observed to have adopted functional coping strategies at baseline, which were maintained through the first 3 years on AS. Overall, men on AS may perceive increasing control over their cancer and comfort with the AS protocol over time and experience slight decreases in anxious preoccupation, cancer-related avoidance thoughts and behaviors, and fight-against-cancer reactions. For those men who find it difficult to cope with AS, psychological monitoring and interventions could be helpful throughout the monitoring journey.
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Affiliation(s)
- Paola Dordoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy.
| | - Fabio Badenchini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | | | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Letizia De Luca
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Teresa Di Florio
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Tiziana Magnani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Cristina Marenghi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lara Bellardita
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
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13
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Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study. PLoS One 2019; 14:e0225134. [PMID: 31747396 PMCID: PMC6867634 DOI: 10.1371/journal.pone.0225134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/29/2019] [Indexed: 12/05/2022] Open
Abstract
Objective Active surveillance (AS) is an increasingly utilized strategy for monitoring men with low-risk prostate cancer (PCa) that allows them to defer active treatment (AT) in the absence of cancer progression. Studies have explored reasons for selecting AS and for then switching to AT, but less is known about men’s experiences being on AS. We interviewed men to determine the clinical and psychological factors associated with selecting and adhering to AS protocols. Methods We conducted semi-structured interviews with men with a low-risk PCa at two academic medical centers. Subjects had either been on AS for ≥ 1 year or had opted for AT after a period of AS. We used an iterative, content-driven approach to analyze the interviews and to identify themes. Results We enrolled 21 subjects, mean age 70.4 years, 3 racial/ethnic minorities, and 16 still on AS. Men recognized the favorable prognosis of their cancer (some had sought second opinions when initially offered AT), valued avoiding treatment complications, were reassured that close monitoring would identify progression early enough to be successfully treated, and trusted their urologists. Although men reported feeling anxious around the time of surveillance testing, those who switched to AT did so based only on evidence of cancer progression. Conclusions Our selected sample was comfortable being on AS because they understood and valued the rationale for this approach. However, this highlights the importance of ensuring that men newly diagnosed with a low-risk PCa are provided sufficient information about prognosis and treatment options to make informed decisions.
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14
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Ruane‐McAteer E, Porter S, O'Sullivan J, Dempster M, Prue G. Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable‐risk prostate cancer patients: A 9‐month longitudinal study. Psychooncology 2019; 28:1743-1752. [DOI: 10.1002/pon.5161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Eimear Ruane‐McAteer
- School of Nursing and Midwifery, Medical Biology CentreQueen's University Belfast Belfast UK
| | - Sam Porter
- Department of Social Sciences and Social WorkBournemouth University Bournemouth UK
| | - Joe O'Sullivan
- The Northern Ireland Cancer CentreBelfast City Hospital Belfast UK
- Centre for Cancer Research and Cell BiologyQueen's University Belfast Belfast UK
| | | | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology CentreQueen's University Belfast Belfast UK
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15
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Matheson L, Wilding S, Wagland R, Nayoan J, Rivas C, Downing A, Wright P, Brett J, Kearney T, Cross W, Glaser A, Gavin A, Watson E. The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK-wide mixed methods study. Psychooncology 2019; 28:1567-1575. [PMID: 31132801 DOI: 10.1002/pon.5133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To address concerns over the psychological impact of being on a monitoring pathway following prostate cancer (PCa) diagnosis, this study compared the psychological status of men on active surveillance (AS) or watchful waiting (WW) with men on active treatment (AT) and explored psychological adjustment in men on AS/WW. METHODS Cross-sectional survey of UK men diagnosed with PCa 18 to 42 months previously (n = 16 726, localised disease at diagnosis) and telephone interviews with 24 men on AS/WW. Psychological outcomes were measured using two validated scales (Short Warwick-Edinburgh Mental Well-being Scale [SWEMWBS] and Kessler Psychological Distress Scale). Univariable and multivariable analyses compared outcomes between men on AS/WW and AT. Thematic analysis of interviews was undertaken, informed by a previously developed theory of adjustment to cancer. RESULTS A total of 3986 (23.8%) respondents were on AS/WW. Overall, psychological outcomes were similar or better in men on AS/WW compared with those receiving AT (SWEMWBS: Poor well-being; 12.3% AS/WW vs 13.9% AT, adjusted OR = 0.86, 95% CI, 0.76-0.97; K6: severe psychological distress; 4.6% vs 5.4%, adjusted OR = 0.90, 95% CI, 0.74-1.08). Interviews indicated that most men on AS/WW had adjusted positively. Men with poorer well-being were less able to accept, reframe positively and normalise their diagnosis, described receiving insufficient information and support, and reported a lack of confidence in their health care professionals. CONCLUSIONS Most men on AS/WW cope well psychologically. Men making treatment decisions should be given this information. Psychological health should be assessed to determine suitability for AS/WW, and at monitoring appointments. A clear action plan and support from health care professionals is important.
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Affiliation(s)
- Lauren Matheson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | | | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anna Gavin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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16
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Menichetti J, De Luca L, Dordoni P, Donegani S, Marenghi C, Valdagni R, Bellardita L. Making Active Surveillance a path towards health promotion: A qualitative study on prostate cancer patients' perceptions of health promotion during Active Surveillance. Eur J Cancer Care (Engl) 2019; 28:e13014. [PMID: 30761643 DOI: 10.1111/ecc.13014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 10/18/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Health promotion is a key aspect for health outcomes of prostate cancer (PCa) patients. However, it has been poorly explored among patients following monitoring programmes, for example Active Surveillance (AS). This study aimed to explore PCa patients' perceptions of health promotion during AS. METHODS An explorative qualitative research design was adopted. Four focus groups were used to collected data from 24 men enrolled in the Prostate Cancer Research International: AS (PRIAS) protocol. A thematic analysis with an inductive approach was performed. RESULTS Participants described promoting health during AS as challenged by mental, age-related, informational and organisational issues. It was reported as an effort to stay in the present with a positive outlook, despite the worries for the future ("the mental theme"). It was perceived as impacted by being older and having to manage physical and mental struggles related to age ("the life-course theme"). It depended, in their accounts, on obtaining reliable information and personalised education ("the educational theme"). Finally, it was related on taking responsibility on the care process ("the organisational theme"). CONCLUSION This study suggested ways of promoting health during AS that can help healthcare professionals and organisations building a "health-promoting AS," able to improve overall health outcomes.
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Affiliation(s)
- Julia Menichetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Letizia De Luca
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Paola Dordoni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Simona Donegani
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Cristina Marenghi
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy.,Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy.,Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Lara Bellardita
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
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17
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Dickey SL, Grayson CJ. The Quality of Life among Men Receiving Active Surveillance for Prostate Cancer: An Integrative Review. Healthcare (Basel) 2019; 7:E14. [PMID: 30678213 PMCID: PMC6473640 DOI: 10.3390/healthcare7010014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
Prostate cancer is very common among men in the United States. The current literature on active surveillance (AS) suggests that it is a promising treatment option for men with low-risk prostate cancer. The purpose of this manuscript is to provide a thorough integrative review regarding the effects of AS on the quality of life (QoL) of men with prostate cancer. Utilizing a methodological strategy, electronic databases were reviewed for empirical articles during the time frame of January 2006 to December 2016. A total of 37 articles met the inclusion criteria wherein 20 focused on the QoL among men only receiving AS and 16 reported QoL among men undergoing AS and other forms of treatment for prostate cancer. The review highlights the purpose, common instruments, race and ethnicity, and strengths and limitations of each article. The majority of articles indicated low levels of anxiety and depression and decreased incidences of bladder, bowel and sexual functioning among men undergoing AS in comparison to men who received other treatment modalities. The results indicated that additional research is needed to determine the QoL among men receiving AS on a longitudinal basis. The results support previous literature that indicated the positive impact of AS on low-risk prostate cancer.
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Affiliation(s)
- Sabrina L Dickey
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA.
| | - Ciara J Grayson
- College of Medicine, Florida State University, Tallahassee, FL 32306, USA.
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18
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Screening of Prostate Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Maggi M, Gentilucci A, Salciccia S, Gatto A, Gentile V, Colarieti A, Von Heland M, Busetto GM, Del Giudice F, Sciarra A. Psychological impact of different primary treatments for prostate cancer: A critical analysis. Andrologia 2018; 51:e13157. [PMID: 30281167 DOI: 10.1111/and.13157] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023] Open
Abstract
Limited attention has been given to the psychological impact of primary treatments in patients with prostate cancer. Aim of our analysis was to critically analyse the current evidence on the psychological impact of different primary treatments (surgery, radiotherapy and active surveillance), in patients with prostate cancer, using validated questionnaires. We searched in the MEDLINE and Cochrane library database from the literature of the past 15 years (primary fields: prostate neoplasm, AND radical prostatectomy or radiotherapy or active surveillance AND psychological distress or anxiety or depression; secondary fields: urinary, sexual, bowel modifications, non-randomised and randomised trials). Overall eighteen original and review articles were included and critically evaluated. Either radical prostatectomy or active surveillance and radiotherapy are well-tolerated in terms of definite anxiety and depression during the post-treatment follow-up. A mutual influence between functional and psychological modifications induced by treatments has been demonstrated. Urinary symptoms related to incontinence more than sexual and bowel dysfunction are able to induce psychological distress worsening. In conclusion, patients and their clinicians might wish to know how functional and psychological aspects may differently be influenced by treatment choice.
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Affiliation(s)
- Martina Maggi
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | - Stefano Salciccia
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Antonio Gatto
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Vincenzo Gentile
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Anna Colarieti
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Magnus Von Heland
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Gian Maria Busetto
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | - Alessandro Sciarra
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
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20
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["Dr. Google"-information-seeking behavior and disease-specific anxiety among men with localized prostate cancer]. Urologe A 2018; 58:1050-1056. [PMID: 30178295 DOI: 10.1007/s00120-018-0769-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE After the diagnosis of localized prostate cancer (LPCa), many men seek additional information about their disease. However, it is not yet proven how different sources of information influence uncertainty and disease-specific anxiety. The aim of this study is to investigate to what extent different types of information sources, the number of used sources and the perceived level of information are predictive of disease-specific anxiety. MATERIALS AND METHODS Men with LPCa (N = 292; n = 150 radical prostatectomy, n = 142 active surveillance) completed questionnaires assessing sociodemographic variables, number and type of sources of information used, perceived level of information, and disease-specific anxiety. The association of information-seeking behavior with anxiety was tested using moderated sequential multiple regression. RESULTS Men were 70 ± 7.2 years old and the survey was taken 47.9 ± 15.4 months after decision for therapy. The multiple regression analysis showed that, after controlling for potential covariates, internet usage (β = 3.28; p > 0.001), number of sources (β = 1.09; p > 0.01) and a lower level of informedness (β = 4.49; p > 0.001) independently predicted variability of anxiety. In addition, the 3‑way interaction (β = 2.03; p > 0.05) accounted for a significant proportion of variance. Overall, the model explained 30% of the criterion variance. CONCLUSIONS Our results show that many men with LPCa already use the internet as a source of information and that this online search is associated with increased disease-specific anxiety. It may be possible to reduce disease-specific anxiety and uncertainty if physicians advise their patients on the selection of reliable online sources.
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21
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Kinsella N, Stattin P, Cahill D, Brown C, Bill-Axelson A, Bratt O, Carlsson S, Van Hemelrijck M. Factors Influencing Men's Choice of and Adherence to Active Surveillance for Low-risk Prostate Cancer: A Mixed-method Systematic Review. Eur Urol 2018; 74:261-280. [PMID: 29598981 PMCID: PMC6198662 DOI: 10.1016/j.eururo.2018.02.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Despite support for active surveillance (AS) as a first treatment choice for men with low-risk prostate cancer (PC), this strategy is largely underutilised. OBJECTIVE To systematically review barriers and facilitators to selecting and adhering to AS for low-risk PC. EVIDENCE ACQUISITION We searched PsychINFO, PubMed, Medline 2000-now, Embase, CINAHL, and Cochrane Central databases between 2002 and 2017 using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The Purpose, Respondents, Explanation, Findings and Significance (PREFS) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) quality criteria were applied. Forty-seven studies were identified. EVIDENCE SYNTHESIS Key themes emerged as factors influencing both choice and adherence to AS: (1) patient and tumour factors (age, comorbidities, knowledge, education, socioeconomic status, family history, grade, tumour volume, and fear of progression/side effects); (2) family and social support; (3) provider (speciality, communication, and attitudes); (4) healthcare organisation (geography and type of practice); and (5) health policy (guidelines, year, and awareness). CONCLUSIONS Many factors influence men's choice and adherence to AS on multiple levels. It is important to learn from the experience of other chronic health conditions as well as from institutions/countries that are making significant headway in appropriately recruiting men to AS protocols, through standardised patient information, clinician education, and nationally agreed guidelines, to ultimately decrease heterogeneity in AS practice. PATIENT SUMMARY We reviewed the scientific literature for factors affecting men's choice and adherence to active surveillance (AS) for low-risk prostate cancer. Our findings suggest that the use of AS could be increased by addressing a variety of factors such as information, psychosocial support, clinician education, and standardised guidelines.
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Affiliation(s)
- Netty Kinsella
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK.
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Declan Cahill
- Department of Urology, The Royal Marsden Hospital, London, UK
| | | | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden
| | - Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Mahran A, Turk A, Buzzy C, Wang M, Yang J, Neudecker M, Jaeger I, Ponsky LE. Younger Men With Prostate Cancer Have Lower Risk of Upgrading While on Active Surveillance: A Meta-analysis and Systematic Review of the Literature. Urology 2018; 121:11-18. [PMID: 30056194 DOI: 10.1016/j.urology.2018.06.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 02/04/2023]
Abstract
Active surveillance has become a popular option for patients with low risk prostate cancer. Our objective was to examine the correlation between age and the risk of Gleason upgrading and biopsy progression. A systematic search was conducted. Eight studies met our eligibility criteria including 6522 patients with a median age of 65.8 (41-86) years. Per decade decrease in age, the pooled odds ratio and hazard ratio (CI 95%) for Gleason upgrading were 0.83 (0.73-0.94) and 0.87 (0.82-0.92), and for biopsy progression were 0.80 (0.74-0.86) and 0.88 (0.79-0.99), respectively. Overall, younger patients have a lower risk of GS upgrading and biopsy progression.
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Affiliation(s)
- Amr Mahran
- Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH; Department of Urology, Assiut University, Egypt
| | - Andrew Turk
- Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Christina Buzzy
- Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Michael Wang
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Julia Yang
- Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Mandy Neudecker
- Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Irina Jaeger
- Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lee E Ponsky
- Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
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23
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Ansmann L, Winter N, Ernstmann N, Heidenreich A, Weissbach L, Herden J. Health-related quality of life in active surveillance and radical prostatectomy for low-risk prostate cancer: a prospective observational study (HAROW - Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting). BJU Int 2018; 122:401-410. [DOI: 10.1111/bju.14215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lena Ansmann
- Department of Health Services Research; Faculty of Medicine and Health Sciences; Carl von Ossietzky University Oldenburg; Oldenburg Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR); Faculty of Human Sciences and Faculty of Medicine; University of Cologne; Cologne Germany
| | - Nicola Winter
- Department of Urology; University Hospital Cologne; Cologne Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research; Department of Psychosomatic Medicine and Psychotherapy; University Hospital Bonn; Bonn Germany
| | - Axel Heidenreich
- Department of Urology; University Hospital Cologne; Cologne Germany
| | | | - Jan Herden
- Department of Urology; University Hospital Cologne; Cologne Germany
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24
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Understanding Urinary Toxicity after Radiotherapy for Prostate Cancer: First Steps Forward. TUMORI JOURNAL 2017; 103:395-404. [DOI: 10.5301/tj.5000681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 01/10/2023]
Abstract
One of the most relevant achievements of Professor Gianni Bonadonna was the implementation of the methodology of controlled clinical trials in medical oncology. It is valid for all cancer types, oncological disciplines and clinical endpoints, both survival and toxicity. This narrative review reports on the status of the current knowledge of the radiation-induced urinary syndrome after external-beam radiotherapy for prostate cancer. In recent years, the syndrome has been the object of large-scale prospective observational trials specifically devoted to investigating the association of patient and treatment features with acute/late urinary toxicity. The first results of these trials allow initial attempts at predictive modeling, which can serve as a basis for the optimization of patient selection and treatment planning.
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25
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Screening of Prostate Cancer. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_67-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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