The Influence of Psychosocial Constructs on the Adherence to Active Surveillance for Localized Prostate Cancer in a Prospective, Population-Based Cohort

To evaluate the influence of psychosocial factors such as prostate cancer (PCa) anxiety, social support, participation in medical decision-making (PDM), and education level on patient decisions to discontinue PCa active surveillance (AS) in the absence of disease progression.

The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based cohort study of men with localized PCa diagnosed in 2011-2012. PCa anxiety, social support, participatory decision making (PDM), education level, and patient reasons for discontinuing AS were assessed through patient surveys. A Cox proportional hazards model examined the relationship between psychosocial variables and time to discontinuing AS.

Of 531 AS patients, 165 (30.9%) underwent treatment after median follow-up of 37 months. Whereas 69% of patients cited only medical reasons for discontinuing AS, 31% cited at least one personal reason, and 8% cited personal reasons only. Patients with some college education discontinued AS significantly earlier (HR: 2.0, 95% CI: 1.2, 3.2) than patients with less education. PCa anxiety, social support, and PDM were not associated with seeking treatment.

We found that 31 percent of men who choose AS for PCa discontinue AS within 3 years. Eight percent of men who sought treatment did so in the absence of disease progression. Education, but not psychosocial factors, seems to influence seeking definitive treatment. Future research is needed to understand how factors unrelated to disease severity influence treatment decisions among AS patients in order to identify opportunities to improve adherence to AS.

Urology. 2017 Feb 09 [Epub ahead of print]

Maximilian F Lang, Mark D Tyson, JoAnn Rudd Alvarez, Tatsuki Koyama, Karen E Hoffman, Matthew J Resnick, Matthew R Cooperberg, Xiao-Cheng Wu, Vivien Chen, Lisa E Paddock, Ann S Hamilton, Mia Hashibe, Michael Goodman, Sheldon Greenfield, Sherrie H Kaplan, Antoinette Stroup, David F Penson, Daniel A Barocas

Vanderbilt University School of Medicine, Nashville, TN. Electronic address: ., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN., Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN., Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA., School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA., Rutgers Cancer Institute of New Jersey, Cancer Surveillance Research Program, New Brunswick, NJ., Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA., Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT., Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA., Center for Health Policy Research and Department of Medicine, University of California Irvine, Irvine, CA., Health Policy Research Institute, University of California Irvine, Irvine, CA., Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN.

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