ASPO Abstracts
Selecting active surveillance: decision-making factors for men with a low-risk prostate cancer
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Behavioral Science & Health Communication
Conference Year: 2018
Abstract Body:
Men with a low-risk prostate cancer (PCa) can opt for active surveillance (AS), a monitoring strategy deferring active treatment (AT) in the absence of disease progression. AS can minimize the harms of overtreatment, but historically most eligible men select AT. We evaluated factors associated with selecting AS. We enrolled 1139 men from Kaiser Permanente Northern California (KPNC) with a low-risk PCa (PSA < 10 ng/mL, Gleason < 7, stage ‰¤ 2a) diagnosed between 2012-14. We conducted telephone surveys within 30 days of diagnosis, collecting data on socio-demographics and clinical history, PCa knowledge, and psychological and decisional factors. We abstracted medical record data on comorbidities and tumor characteristics. We classified men as selecting AS if they remained continually enrolled in KPNC and did not undergo active treatment (surgery, radiotherapy, or hormone therapy) within a year of diagnosis. We used multivariable logistic regression analyses to identify factors associated with selecting AS. We evaluated 1118 subjects, median age 62, 81% white, 19% < college education; 637 (57%) opted for AS. Significant predictors for selecting AS were increasing age (70+ vs < 50, OR = 4.7;95% CI 1.8-12.6), being aware of low-risk status (1.7;1.0-3.0), knowing that AS was an option (3.6; 1.6-8.1), wanting to avoid sexual dysfunction (1.5;1.0-2.1) and radiation exposure (2.4;1.6-3.6), and a urologist recommendation for AS (6.3;3.9-10.3). Conversely, wanting to be cured of cancer (2.2;1.3-3.9), greater anxiety (1.5;1.1-2.1), greater decision confidence (2.2; 1.5-3.1), and having higher PSA levels (1.2;1.0-1.3), clinical stage (2.2;1.2-4.1), and percent positive biopsy cores (>25% vs. <10%, 4.3;2.8-6.7) were associated with AT. A substantial proportion of subjects selected AT and decisions were associated with tumor characteristics, demographics, comorbidity, and personal values. Men selecting AS were more knowledgeable about PCa prognosis and treatment options. Although supported by urologists in selecting AS, these men were less confident in their decision than those selecting AT. Efforts to provide comprehensive early decision support to men with low-risk cancers may facilitate better informed decision making and potentially increase AS uptake.
Keywords: prostate cancer decision making active surveillance