Patients' perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy

Treatment choice for localized prostate cancer (PCa) is a controversial issue, and mortality risk is probably the most decisive factor in this regard. The study aimed to compare prostate-cancer-specific mortality risk estimates for different treatment options assigned by patients managed with active surveillance (AS), radical prostatectomy (RP), and patients who had discontinued AS (DAS).

We matched patients initially managed with AS or RP (N = 370) according to length of therapy. Patients completed mailed questionnaires assessing their mortality risk estimates (in %) and prostate-cancer-specific anxiety. We analyzed differences in risk estimates among the three treatment groups using ANOVA, relationships of clinical and psychosocial variables with risk estimates using standard multiple regression. In all treatment groups, the prostate- cancer-specific mortality risk was overestimated. This applied whether it was the patient's own treatment or the alternative treatment option. RP patients assigned a mortality risk to AS that was almost three times higher than that assigned to RP (50.9±25.0 vs. 17.8±19.7, d = 1.48; p <.001). Anxiety was significantly associated with risk estimates for AS (p = .008) and RP (p = .001). Compared to clinical data that suggest that the prostate-cancer-specific mortality risk for AS is low and does not significantly differ from that for RP, patients strongly overestimated the mortality risk. This was most markedly so in RP patients, who drastically overestimated the benefits of RP compared to the risk of AS. This overestimation could increase overtreatment and should therefore be corrected by better patient education. This article is protected by copyright. All rights reserved.

International journal of cancer. 2016 Apr 02 [Epub ahead of print]

Friederike Kendel, Lukas Helbig, Konrad Neumann, Jan Herden, Carsten Stephan, Mark Schrader, Wolfgang Gaissmaier

Institute of Medical Psychology, Charité - Universitaetsmedizin Berlin., Institute of Medical Psychology, Charité - Universitaetsmedizin Berlin., Institute of Medical Biometrics and Clinical Epidemiology, Charité - Universitaetsmedizin Berlin., Department of Urology, University of Cologne., Department of Urology, Charité - Universitaetsmedizin Berlin and Berlin Institute for Urologic Research, Berlin, Germany., Department of Urology, HELIOS Clinic Berlin-Buch., Department of Social Psychology and Decision Sciences, University of Konstanz.