Men’s and partners’ reactions to localised prostate cancer: Medical and community education on treatment options is needed (#100)
Abstract
Aims. The shift in localized prostate cancer (LPC) management to include active surveillance (AS), alongside radical treatment options (radical prostatectomy, external beam radiotherapy, brachytherapy),1 has added complexity to treatment decision-making.2 This study examined men with LPC and partners’ experiences of choosing between AS and radical treatments when AS was recommended. It also examined men’s and partners’ experiences of AS when selected. Method. Qualitative descriptive research design.3 Sampling was purposive. Interviewed participants were men, and partners of men who had either chosen radical treatment immediately following diagnosis, or had been on AS for ≥ 3 months. Clinical eligibility criteria for AS recommendation were: T1-2a tumours, Gleason score ≤6, and PSA <10 ng/mL. Additionally, one urologist included men with one of: T2b-T2c tumour, PSA 10–20 ng/mL, or Gleason score 7. Audio-recorded and transcribed interviews were thematically analysed using grounded theory techniques, i.e., inductive, cyclic, and constant comparative analysis.4 Results. Twenty-one men and 14 partners participated. Prostate cancer information used to inform treatment decisions was regularly described as contradictory, confusing, and stressful. Some preferred doctors to select treatments. Radical treatment could be selected when cancer progression was feared. AS was commonly misunderstood but all described monitoring procedures. Men and partners usually coped with AS but were sometimes encumbered by memories of treatment decision-making, painful biopsies, and ongoing conflicting information. Partners often implied they were also on AS. Men who immediately chose radical treatment were difficult to recruit, preventing data saturation. Conclusion. To reduce distress, frequently experienced by men diagnosed with LPC and their partners during treatment decision-making and AS monitoring, there is a need for improved community and medical education about AS eligibility, and availability of consistent, unbiased information about LPC prognoses, treatment options, and side effects. Discussion about inconsistent information and how recommendation to cease AS is made could be useful.5
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- O’Callaghan C, Dryden T, Hyatt A, Brooker J, Burney S, Wootten A, White A, Frydenberg M, Murphy D, Williams S, Schofield P. (2014; Epub ahead of print). “What is this active surveillance thing?” Men's and partners’ reactions to treatment decision-making for prostate cancer when active surveillance is the recommended treatment option. Psycho-Oncology. DOI: 10.1002/pon.3576.