Quality of life among men with low-risk prostate cancer during the first year following diagnosis: the PREPARE prospective cohort study

Shared medical decision in prostate cancer screening in primary care: a systematic literature review of current evidence

PURPOSE

Prostate cancer screening has not significantly reduced mortality. International guidelines strongly endorse shared decision-making to navigate risks, emphasizing its crucial role prior to prescribing a prostate-specific antigen test. This study aims to provide insight into the current role of shared decision-making in primary care for prostate cancer screening and suggest ways to improve the process.

METHODS

PubMed, Cochrane, and Lissa databases were searched for following terms: 'prostate-specific antigen' or 'prostate cancer screening' combined with 'shared decision making', 'informed decision making' or 'decision support' and 'primary care'. All studies were screened by two independent reviewers. This systematic review followed the PRISMA guidelines.

RESULTS

Of 85 articles screened, 34 were included. Key findings included heterogenous and poor quality implementation of shared decision-making in practice, patients with limited knowledge of shared decision-making, clinicians infrequently discussing patients' views, decision aids that could be better integrated into practice, and finally, changes in care systems to support the expansion of shared decision-making in prostate cancer screening.

CONCLUSION

Decision aids are essential tools in the informed decision-making process. Integrating these elements into practice would require training for doctors and adjustments to the healthcare system.

Patient perspectives on factors influencing active surveillance adherence for low-risk prostate cancer: A qualitative study

BACKGROUND

Prostate cancer is the most common cancer among men in the United States. Treatment guidelines recommend active surveillance for low-risk prostate cancer, which involves monitoring for progression, to avoid or delay definitive treatments and their side effects. Despite increased uptake, adherence to surveillance remains a challenge.

METHODS

We conducted semi-structured, qualitative, virtual interviews based on the Theoretical Domains Framework (TDF), with men (15) who were or had been on active surveillance for their low-risk prostate cancer in 2020. Interviews were transcribed and coded under TDF's behavioral theory-based domains. We analyzed domains related to adherence to surveillance using constructivist grounded theory to identify themes influencing decision processes in adherence.

RESULTS

The TDF domains of emotion, beliefs about consequences, environmental context and resources, and social influences were most relevant to surveillance adherence-. From these four TDF domains, three themes emerged as underlying decision processes: trust in surveillance as treatment, quality of life, and experiences of self and others. Positive perceptions of these three themes supported adherence while negative perceptions contributed to non-adherence (i.e., not receiving follow-up or stopping surveillance). The relationship between the TDF domains and themes provided a theoretical process describing factors impacting active surveillance adherence for men with low-risk prostate cancer.

CONCLUSIONS

Men identified key factors impacting active surveillance adherence that provide opportunities for clinical implementation and practice improvement. Future efforts should focus on multi-level interventions that foster trust in surveillance as treatment, emphasize quality of life benefits and enhance patients' interpersonal experiences while on surveillance to optimize adherence.

Irreversible electroporation as a focal therapy for localized prostate cancer: A systematic review

Introduction

Irreversible electroporation (IRE) is a new and promising focal therapy for the treatment of localized prostate cancer. In this systematic review, we summarize the literature on IRE for prostate cancer published over the last decade.

Methods

PubMed and EMBASE were searched with the end date of May 2023 to find relevant publications on prostate cancer ablation using IRE. Original studies with focal IRE as the primary curative treatment which reported on functional or oncological outcomes were included. The bibliography of relevant studies was also scanned to identify suitable articles.

Results

A total of 14 studies reporting on 899 patients treated with IRE for localized prostate cancer were included. Of all the studies reviewed, 77% reported on recurrence within the zone of ablation, and it ranged from 0% to 38.9% for in-field and 3.6% to 28% for out-of-field recurrence. Although, a standardised follow-up protocol was not followed, all the studies employed serial prostate-specific antigen monitoring, a multiparametric magnetic resonance imaging, and a biopsy (6-12 months post-treatment). Across all the studies, 58% reported that the urinary continence returned to the pretreatment levels and 25% reported a minor decrease in the continence from the baseline at 12-months of follow-up. Erections sufficient for intercourse varied from 44% to 75% at the baseline to 55% to 100% at 12-months of follow-up across all the studies.

Conclusion

IRE, as a focal therapy, shows promising results with minimal complications and reasonably effective oncological control, but the data comparing it to the standard of care is still lacking. Future research should focus on randomized definitive comparisons between IRE, radical prostatectomy, and radiation therapy.

Psychological predictors of delayed active treatment following active surveillance for low‐risk prostate cancer: The Patient REported outcomes for Prostate cARE prospective cohort study

Objectives

In a prospective, comparative effectiveness study, we assessed clinical and psychological factors associated with switching from active surveillance (AS) to active treatment (AT) among low‐risk prostate cancer (PCa) patients.

Methods

Using ultra‐rapid case identification, we conducted pretreatment telephone interviews (N = 1139) with low‐risk patients (PSA ≤ 10, Gleason≤6) and follow‐up interviews 6–10 months post‐diagnosis (N = 1057). Among men remaining on AS for at least 12 months (N = 601), we compared those who continued on AS (N = 515) versus men who underwent delayed AT (N = 86) between 13 and 24 months, using Cox proportional hazards models.

Results

Delayed AT was predicted by time dependent PSA levels (≥10 vs. <10; HR = 5.6, 95% CI 2.4–13.1) and Gleason scores (≥7 vs. ≤6; adjusted HR = 20.2, 95% CI 12.2–33.4). Further, delayed AT was more likely among men whose urologist initially recommended AT (HR = 2.13, 95% CI 1.07–4.22), for whom tumour removal was very important (HR = 2.18, 95% CI 1.35–3.52), and who reported greater worry about not detecting disease progression early (HR = 1.67, 1.05–2.65). In exploratory analyses, 31% (27/86) switched to AT without evidence of progression, while 4.7% (24/515) remained on AS with evidence of progression.

Conclusions

After adjusting for clinical evidence of disease progression over the first year post‐diagnosis, we found that urologists' initial treatment recommendation and patients' early treatment preferences and concerns about AS each independently predicted undergoing delayed AT during the second year post‐diagnosis. These findings, along with almost one‐half undergoing delayed AT without evidence of progression, suggest the need for greater decision support to remain on AS when it is clinically indicated.

Patient perception of receiving a thyroid cancer diagnosis

PURPOSE OF REVIEW

This review describes the current state of the literature on patients' perceptions of receiving a diagnosis of thyroid cancer. The evaluation progresses from people's understanding about thyroid cancer in general to the lived experiences of those receiving an initial diagnosis or one of recurrence. The implications on patients' quality of life and treatment decisions are also discussed.

RECENT FINDINGS

Receiving a diagnosis of thyroid cancer often elicits intense and immediate emotions of shock and fear evoked by the word 'cancer,' which may be related to lack of knowledge about thyroid cancer specifically. Describing thyroid cancer as the 'good cancer' in an attempt to reassure patients is not necessarily reassuring and can inadvertently minimize the impact of a patient's diagnosis. Fear and worry about cancer in general and the possibility for recurrence contribute to lasting psychological distress and decreased quality of life. Patients' perceptions of their diagnosis and resulting emotional reactions influence treatment decision-making and have the potential to contribute to decisions that may over-treat a low-risk thyroid cancer.

SUMMARY

Understanding patients' experience of receiving a thyroid cancer diagnosis is critical because their emotional reactions can have a profound impact on treatment decision-making and quality of life.

The psychological impact of active surveillance in men with prostate cancer: implications for nursing care

INTRODUCTION

Active surveillance is a conservative management approach to treating prostate cancer involving regular testing and close monitoring by the health professional. The aim of this literature review is to establish whether men experience a psychological impact of active surveillance and what the prevalent effects might be.

METHOD

The search was carried out in three databases: CINAHL, Medline and PsycINFO. Articles published in English, from October 2015 to March 2018, which focused on the psychological impact of active surveillance, were included.

FINDINGS

A total of eight quantitative studies were included in this report. The review identified key psychological impacts of active surveillance, including anxiety, sub-clinical depression, illness uncertainty and hopelessness. Active surveillance was seen by some patients as a positive treatment approach that limited the side effects associated with active treatment.

CONCLUSION

The evidence found a negative impact of active surveillance might be felt by men at any stage during treatment and at differing levels of severity. The article highlights key demographic areas, including ethnicity and age, for future research and recommends more qualitative studies are conducted.

Identifying the exercise-based support needs and exercise programme preferences among men with prostate cancer during active surveillance: A qualitative study

PURPOSE

This study aims to investigate the attitudes and preferences men on active surveillance for prostate cancer have regarding exercise and exercise-based support. Exercise outcomes align with traditionally masculine values, can improve mental and physical health, and may even slow early stage prostate cancer progression. However, attitudes and preferences towards exercise and exercise support are unexplored in men on active surveillance.

METHODS

Semi-structured qualitative interviews were conducted with participants (13 males with a history of active surveillance for prostate cancer; 5 female partners). Interviews were conducted either by telephone or in person and audiotaped, transcribed verbatim, and thematically analysed.

RESULTS

Several key themes were identified relating to the two research aims: 'Attitudes and Preferences towards Exercise, and 'Attitudes and Preferences towards Exercise Support'. Despite all men engaging in exercise, the majority did not meet the recommended guidelines for cancer survivors. The majority of men either were interested in receiving exercise support or had previously received it, often recommending this for all men on active surveillance. There were varied preferences regarding delivery modality (i.e., online or face to face), the inclusion of partners, and group versus individual formats.

CONCLUSIONS

This study provides a novel insight into the attitudes and preferences of men on active surveillance regarding exercise and support. This research will help the development of acceptable and accessible person-centred support for men on active surveillance. However, further research is needed to evaluate the efficacy of different delivery modalities in this population.

Cognitive function, depression, and anxiety in patients undergoing radical prostatectomy with and without adjuvant treatment

BACKGROUND

Prostate cancer (PC) is one of the most common malignant tumors in developed countries. Both PC and treatment for PC have an adverse impact on physical and mental well-being, and are associated with decreased quality of life. The aim of the present study was to examine the relationship between neuropsychological symptoms and clinical course in PC patients undergoing radical prostatectomy with or without adjunct therapy.

METHODS

The cohort comprised 100 patients aged 50-77 years who underwent radical, laparoscopic prostatectomy for PC. Twenty-three patients with a more advanced clinical stage also received adjuvant therapy (radiotherapy and hormonotherapy). Clinical evaluation included self-report assessment, physical examination, and biochemical tests (testosterone and prostate-specific antigen). In addition, the presence and intensity of sexual dysfunction, urinary dysfunction, anxiety-depressive symptoms, and cognitive dysfunction were assessed.

RESULTS

The group of patients undergoing complex therapy was characterized by a significantly worse result of deferred memory (p=0.04). A significant correlation was found between post-surgery erectile function and scores for the visual working memory test (correct answers; VWMT-C; p=0.006) and Hospital Anxiety and Depression Scale depression (p=0.045) and anxiety scores (p=0.02). A trend toward significance was also observed for simple reaction time (correct answers; p=0.09). A significant correlation was found between results for the delayed verbal memory test and all physical symptoms (International Consultation on Incontinence Questionnaire-total, p=0.02; International Index of Erectile Function-5, p=0.006). Similarly, a significant correlation was found between the VWMT-C and score for sexual dysfunction (p=0.003).

CONCLUSION

Patients undergoing both surgical and adjunct therapy for PC are at risk for psychological burden and cognitive disorders. In the present cohort, physical complications of therapy were associated with depression, anxiety, and delayed memory dysfunction. Furthermore, this study has proven that fewer complications after surgery are associated with better psychological and cognitive functioning. Appropriate neuropsychological and psychiatric care can improve compliance and quality of life among patients after prostatectomy.