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Al Hussein Al Awamlh B, Wallis CJD, Diehl C, Barocas DA, Beskow LM. The lived experience of prostate cancer: 10-year survivor perspectives following contemporary treatment of localized prostate cancer. J Cancer Surviv 2024; 18:1370-1383. [PMID: 37171717 DOI: 10.1007/s11764-023-01381-6] [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: 01/16/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Studies relying on standardized instruments to measure patient-centered harms and benefits of cancer treatment may fail to capture important elements of the lived experience of cancer patients. Further, qualitative studies on the survivorship experience of men with localized prostate cancer (PCa) are limited. We sought to explore the early experience, long-term experience, and advice provided for others among long-term survivors of localized PCa. METHODS Semi-structured qualitative interviews with a subset (n = 66) of respondents to a survey of 10-year PCa survivors who underwent active surveillance, radical prostatectomy, or radiotherapy. Topics included early and long-term experiences and advice to other men and physicians. RESULTS Immediately after treatment, men were mostly satisfied with radiation and active surveillance due to remaining whole and avoiding surgical removal of the prostate. Meanwhile, men treated with surgery felt relieved by the removal of cancer. Some early negative perception was related to short-term anxiety, particularly among men who underwent active surveillance. Long-term experiences included accepting the trade-offs of urinary and sexual side effects with survival. Most men fared well financially, some had strengthened relationships, and many reported greater appreciation and compassion. Men provided essential advice to other men and physicians on the importance of gathering detailed information on treatments and establishing a strong relationship with physicians. CONCLUSIONS Long-term survivors of localized PCa generally do well by accepting the long-term effects of contemporary treatments, experiencing strengthened relationships, and developing a better overall life approach. IMPLICATIONS FOR CANCER SURVIVORS We provide useful perspectives and insights for men opting to use current-day treatments for localized PCa.
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Affiliation(s)
- Bashir Al Hussein Al Awamlh
- Department of Urology, Medical Center North, Vanderbilt University Medical Center, 1161 21st Avenue South, A-1302, Nashville, TN, 37232, USA.
| | | | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Medical Center North, Vanderbilt University Medical Center, 1161 21st Avenue South, A-1302, Nashville, TN, 37232, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
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Pattenden TA, Thangasamy IA, Ong WL, Samaranayke D, Morton A, Murphy DG, Evans S, Millar J, Chalasani V, Rashid P, Winter M, Vela I, Pryor D, Mark S, Loeb S, Lawrentschuk N, Pritchard E. Barriers and enablers of active surveillance for prostate cancer: a qualitive study of clinicians. BJU Int 2024; 133 Suppl 3:48-56. [PMID: 37696615 DOI: 10.1111/bju.16176] [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] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To identify and explore barriers to, and enablers of, active surveillance (AS) in men with low-risk prostate cancer (LRPCa), as perceived by PCa clinicians. PATIENTS AND METHODS Urologists and radiation oncologists in Australia and New Zealand were purposively sampled for a cross-section on gender and practice setting (metropolitan/regional; public/private). Using a grounded theory approach, semi-structed interviews were conducted with participants. Interviews were coded independently by two researchers using open, axial, and selective coding. A constant comparative approach was used to analyse data as it was collected. Thematic saturation was reached after 18 interviews, and a detailed model of barriers to, and enablers of, AS for LRPCa, as perceived by clinicians was developed. RESULTS A model explaining what affects clinician decision making regarding AS in LRPCa emerged. It was underpinned by three broad themes: (i) clinician perception of patients' barriers and enablers; (ii) clinician perception of their own barriers and enablers; and (iii) engagement with healthcare team and resource availability. CONCLUSIONS Clinicians unanimously agree that AS is an evidence-based approach for managing LRPCa. Despite this many men do not undergo AS for LRPCa, which is due to the interplay of patient and clinician factors, and their interaction with the wider healthcare system. This study identifies strategies to mitigate barriers and enhance enablers, which could increase access to AS by patients with LRPCa.
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Affiliation(s)
- Trent A Pattenden
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Isaac A Thangasamy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Dhanika Samaranayke
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Morton
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Venu Chalasani
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Prem Rashid
- Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Ian Vela
- Australian Prostate Cancer Research Centre - Queensland, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Urology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Stephen Mark
- Department of Urology, Christchurch Hospital, Christchurch, New Zealand
| | - Stacy Loeb
- New York University, New York City, NY, USA
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre, Epworth, Melbourne, Victoria, Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Subramanian L, Hawley ST, Skolarus TA, Rankin A, Fetters MD, Witzke K, Chen J, Radhakrishnan A. Patient perspectives on factors influencing active surveillance adherence for low-risk prostate cancer: A qualitative study. Cancer Med 2024; 13:e6847. [PMID: 38151901 PMCID: PMC10807559 DOI: 10.1002/cam4.6847] [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: 08/10/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
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.
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Affiliation(s)
- Lalita Subramanian
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah T. Hawley
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Ted A. Skolarus
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Department of Surgery, Urology SectionUniversity of ChicagoChicagoIllinoisUSA
| | - Aaron Rankin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | | - Karla Witzke
- Department of UrologyMyMichigan HealthMidlandMichiganUSA
| | - Jason Chen
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Archana Radhakrishnan
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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Midya A, Hiremath A, Huber J, Sankar Viswanathan V, Omil-Lima D, Mahran A, Bittencourt LK, Harsha Tirumani S, Ponsky L, Shiradkar R, Madabhushi A. Delta radiomic patterns on serial bi-parametric MRI are associated with pathologic upgrading in prostate cancer patients on active surveillance: preliminary findings. Front Oncol 2023; 13:1166047. [PMID: 37731630 PMCID: PMC10508842 DOI: 10.3389/fonc.2023.1166047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/24/2023] [Indexed: 09/22/2023] Open
Abstract
Objective The aim of this study was to quantify radiomic changes in prostate cancer (PCa) progression on serial MRI among patients on active surveillance (AS) and evaluate their association with pathologic progression on biopsy. Methods This retrospective study comprised N = 121 biopsy-proven PCa patients on AS at a single institution, of whom N = 50 at baseline conformed to the inclusion criteria. ISUP Gleason Grade Groups (GGG) were obtained from 12-core TRUS-guided systematic biopsies at baseline and follow-up. A biopsy upgrade (AS+) was defined as an increase in GGG (or in number of positive cores) and no upgrade (AS-) was defined when GGG remained the same during a median period of 18 months. Of N = 50 patients at baseline, N = 30 had MRI scans available at follow-up (median interval = 18 months) and were included for delta radiomic analysis. A total of 252 radiomic features were extracted from the PCa region of interest identified by board-certified radiologists on 3T bi-parametric MRI [T2-weighted (T2W) and apparent diffusion coefficient (ADC)]. Delta radiomic features were computed as the difference of radiomic feature between baseline and follow-up scans. The association of AS+ with age, prostate-specific antigen (PSA), Prostate Imaging Reporting and Data System (PIRADS v2.1) score, and tumor size was evaluated at baseline and follow-up. Various prediction models were built using random forest (RF) classifier within a threefold cross-validation framework leveraging baseline radiomics (Cbr), baseline radiomics + baseline clinical (Cbrbcl), delta radiomics (CΔr), delta radiomics + baseline clinical (CΔrbcl), and delta radiomics + delta clinical (CΔrΔcl). Results An AUC of 0.64 ± 0.09 was obtained for Cbr, which increased to 0.70 ± 0.18 with the integration of clinical variables (Cbrbcl). CΔr yielded an AUC of 0.74 ± 0.15. Integrating delta radiomics with baseline clinical variables yielded an AUC of 0.77 ± 0.23. CΔrΔclresulted in the best AUC of 0.84 ± 0.20 (p < 0.05) among all combinations. Conclusion Our preliminary findings suggest that delta radiomics were more strongly associated with upgrade events compared to PIRADS and other clinical variables. Delta radiomics on serial MRI in combination with changes in clinical variables (PSA and tumor volume) between baseline and follow-up showed the strongest association with biopsy upgrade in PCa patients on AS. Further independent multi-site validation of these preliminary findings is warranted.
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Affiliation(s)
- Abhishek Midya
- Department of Biomedical Engineering, Emory University, Atlanta, GA, United States
| | | | - Jacob Huber
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | | | | | - Amr Mahran
- Department of Urology, Assiut University, Asyut, Egypt
| | - Leonardo K. Bittencourt
- Department of Radiology, University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Lee Ponsky
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Rakesh Shiradkar
- Department of Biomedical Engineering, Emory University, Atlanta, GA, United States
| | - Anant Madabhushi
- Department of Biomedical Engineering, Emory University, Atlanta, GA, United States
- Atlanta Veterans Administration Medical Center, Atlanta, GA, United States
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Victorson D, Morgan T, Kutikov A, Novakovic K, Kundu S, Horowitz B, Jackson K, Addington E, Murphy K, Sauer C, Brendler C. Mindfulness-based stress reduction for men on active surveillance for prostate cancer and their spouses: Design and methodology of a randomized controlled trial. Contemp Clin Trials 2023; 125:107059. [PMID: 36563902 PMCID: PMC9918709 DOI: 10.1016/j.cct.2022.107059] [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: 08/28/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although active surveillance (AS) is an increasingly adopted treatment paradigm for management of very low risk prostate cancer, many men and their partners face a variety of AS-related psychosocial stressors. Stressors may include anxiety and fear of progression, which may negatively affect short- and long-term psychosocial adjustment and influence early withdrawal from AS in order to seek definitive therapies such as surgery or radiation. Here we describe the protocol for an NCI-funded trial, which seeks to examine the efficacy of mindfulness training compared with a time/attention-matched health promotion control condition in a geographically generalizable sample of men on AS and their spouses. METHODS Using a randomized, controlled, partially double-blinded study design, this study involves the delivery of 8 weeks of standardized mindfulness training (MBSR; mindfulness-based stress reduction) and patient reported outcomes over a 12-month period (proposed enrollment of 80 men on AS and spouses), compared with a health promotion control (proposed enrollment of 80 men on AS and spouses) that has been matched for time and attention. Baseline (T1) measures (e.g., anxiety, fear of progression, quality of life) are administered just prior to randomization to the two study arms, followed by repeated assessments at 2 months (T2), 6 months (T3) and 12 months (T4). CONCLUSION This study has the potential to offer men and their partners on AS with important educational and self-regulatory skills to better cope and adjust with known stressors related to being placed on this protocol.
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Affiliation(s)
- David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Todd Morgan
- University of Michigan, Department of Urology, Ann Arbor, MI, USA
| | | | - Kristian Novakovic
- John and Carol Walter Center for Urological Health, NorthShore University Health System, Evanston, IL, USA
| | - Shilajit Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruriah Horowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathryn Jackson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karly Murphy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina Sauer
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charles Brendler
- John and Carol Walter Center for Urological Health, NorthShore University Health System, Evanston, IL, USA
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Kirk PS, Zhu K, Zheng Y, Newcomb LF, Schenk JM, Brooks JD, Carroll PR, Dash A, Ellis WJ, Filson CP, Gleave ME, Liss M, Martin F, McKenney JK, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Lin DW, Gore JL. Treatment in the absence of disease reclassification among men on active surveillance for prostate cancer. Cancer 2022; 128:269-274. [PMID: 34516660 PMCID: PMC8738121 DOI: 10.1002/cncr.33911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Maintaining men on active surveillance for prostate cancer can be challenging. Although most men who eventually undergo treatment have experienced clinical progression, a smaller subset elects treatment in the absence of disease reclassification. This study sought to understand factors associated with treatment in a large, contemporary, prospective cohort. METHODS This study identified 1789 men in the Canary Prostate Cancer Active Surveillance Study cohort enrolled as of 2020 with a median follow-up of 5.6 years. Clinical and demographic data as well as information on patient-reported quality of life and urinary symptoms were used in multivariable Cox proportional hazards regression models to identify factors associated with the time to treatment RESULTS: Within 4 years of their diagnosis, 33% of men (95% confidence interval [CI], 30%-35%) underwent treatment, and 10% (95% CI, 9%-12%) were treated in the absence of reclassification. The most significant factor associated with any treatment was an increasing Gleason grade group (adjusted hazard ratio [aHR], 14.5; 95% CI, 11.7-17.9). Urinary quality-of-life scores were associated with treatment without reclassification (aHR comparing "mostly dissatisfied/terrible" with "pleased/mixed," 2.65; 95% CI, 1.54-4.59). In a subset analysis (n = 692), married men, compared with single men, were more likely to undergo treatment in the absence of reclassification (aHR, 2.63; 95% CI, 1.04-6.66). CONCLUSIONS A substantial number of men with prostate cancer undergo treatment in the absence of clinical changes in their cancers, and quality-of-life changes and marital status may be important factors in these decisions. LAY SUMMARY This analysis of men on active surveillance for prostate cancer shows that approximately 1 in 10 men will decide to be treated within 4 years of their diagnosis even if their cancer is stable. These choices may be related in part to quality-or-life or spousal concerns.
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Affiliation(s)
- Peter S. Kirk
- Department of Urology, University of Washington, Seattle, WA
| | - Kehao Zhu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yingye Zheng
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa F. Newcomb
- Department of Urology, University of Washington, Seattle, WA
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jeannette M. Schenk
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Peter R. Carroll
- Department of Urology, University of California, San Francisco, CA
| | - Atreya Dash
- VA Puget Sound Health Care Systems, Seattle, WA
| | | | | | - Martin E. Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Michael Liss
- Department of Urology, University of Texas Health Sciences Center, San Antonio, TX
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, VA
| | - Jesse K. McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Peter S. Nelson
- Division of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Daniel W. Lin
- Department of Urology, University of Washington, Seattle, WA
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John L. Gore
- Department of Urology, University of Washington, Seattle, WA
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