Editor's Commentary - Factors that influence patient enrollment in active surveillance for low-risk prostate cancer

BERKELEY, CA (UroToday.com) - According to a report in by Dr. Mark Soloway and collaborators that appears in the online version of Urology, physician influence is the greatest contributor to a patient’s decision to participate in active surveillance (AS) for prostate cancer (CaP).

Among the CaP patient subset with very low risk disease, only a minority of patients meeting eligibility criteria utilized AS. In this University of Miami study, 185 AS patients were mailed a rank-order survey and asked to assess the relative influence of 12 variables that might have contributed to their decision of whether or not to enroll in AS. These included; not wanting surgery, not wanting radiotherapy, other health issues, having a friend on AS who is happy with the choice, concerned about ED, concerned about incontinence, the physician thinking AS a reasonable choice, patient determined best choice, family support for AS, confidence that cure was still possible if CaP progressed while on AS, no anxiety about their CaP, and having a friend on AS who was not happy with the results.

The questionnaire was returned by 105 of the 185 men (57%). Median time enrolled in AS at the time of survey was 20.5 months. Among responses, the physician thinking AS a reasonable choice was most commonly ranked first, followed by feeling certain that cure was possible if CaP progressed, and patient derived conclusion that AS was best. Among side effects, 48% were most concerned about incontinence and 44% about ED. Having other health issues was the least ranked answer. The physician who had made the initial diagnosis offered AS to only 36% of the 105 men, suggesting that it is uncommonly discussed with patients in this region and referral practice.

Gorin MA, Soloway CT, Eldefrawy A, Soloway MS

 

Urology. 2011 Mar;77(3):588-91
10.1016/j.urology.2010.10.039

 

PubMed Abstract
PMID: 21215429

 

UroToday.com Prostate Cancer Section

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