Elsevier

Urology

Volume 77, Issue 3, March 2011, Pages 588-591
Urology

Health Outcomes Research
Factors That Influence Patient Enrollment in Active Surveillance for Low-risk Prostate Cancer

https://doi.org/10.1016/j.urology.2010.10.039Get rights and content

Objectives

To learn from patients their rationale for enrollment in active surveillance (AS) for low-risk prostate cancer as an alternative to primary treatment.

Methods

A rank-order survey was designed to assess the relative influence of factors that contributed to the decision to elect AS. The survey was mailed to 185 patients enrolled in AS at our university-based urologic oncology practice. Participants were also asked whether they had been offered AS as an alternative to primary treatment by the urologist who had initially diagnosed their cancer.

Results

The survey was returned by 105 (57%) of 185 patients. AS was offered to 38 (36%) of 105 patients by the physician who had made the initial diagnosis. Patients most frequently reported physician influence as the greatest contributor to their decision to elect AS (73%). Patients also cited concerns regarding the potential side effects of incontinence (48%) and erectile dysfunction (44%) associated with therapy as reasons for choosing AS.

Conclusions

The results of the present study have shown that patients are heavily influenced by physicians in their decision to elect AS. Notably, the majority of our sampled patients were not offered AS at diagnosis. Evidence has indicated that AS is an appropriate approach for low-risk prostate cancer and should be discussed with patients in this risk category.

Section snippets

AS Protocol

At our institution, AS is offered to PCa patients with the following characteristics: PSA level of ≤10 ng/mL, Gleason score of ≤6, ≤2 positive biopsy cores with tumor of ≤20% in each core, and age ≤80 years.7, 10 Before enrolling in AS, patients receive extensive counseling regarding all treatment options for localized PCa, including AS. Patients are given pamphlets and relevant literature on the different treatment options. With the permission of the patient, family members are invited to

Results

The questionnaire was returned by 105 (57%) of 185 patients. Surveys were not returned during normal follow-up visits but rather by mail as a part of a research protocol. The mean age of the respondents was 65.5 years. Median time enrolled in AS at survey was 20.5 months. AS was offered by the physician who had made the initial diagnosis for 38 (36%) of 105 patients. Statements receiving the greatest number of 1s included: “My doctor thought it was a reasonable alternative”; “I felt sure I

Comment

Patients most frequently reported physician influence as the greatest contributor to their decision to enroll in AS. This finding was consistent with those from other studies that found that patients with PCa rely heavily on the recommendations of physicians in their choice of treatment.13, 14, 15, 16 Thus, physicians should present unbiased information in their discussions with patients. Only 36% of respondents were offered AS by the urologist who had first diagnosed their PCa. Thus, a

Conclusions

Despite guidelines and evidence that support AS for low-risk PCa as an alternative to primary therapy, many physicians failed to introduce this management approach. Of the patients who elect AS, physician influence was most frequently cited as the greatest contributor to their decision for AS. Patients also relied on independent research and the influence of family. Our work has yielded findings similar to other studies that have evaluated factors that influence patient preference for

Acknowledgment

To “CURED” and Vincent A. Rodriguez.

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