Psychological and quality-of-life effects of remaining on active surveillance at 9 to 11 years after diagnosis of low-risk localised prostate cancer

Abstract

Introduction & Objectives: Randomised trials using intention‐to‐treat analyses have concluded that low‐risk localised prostate cancer patients who initially commence active surveillance have similar long‐term psychological outcomes as those who initially have active treatment for their cancer. However, given that many men who commence active surveillance will eventually receive radical treatment, intention‐to‐treat analysis may be inappropriate for estimating the long‐term effects of remaining on active surveillance. We compared the psychological and quality‐of‐life outcomes for low‐risk localised prostate cancer patients who remained on active surveillance at 9–11 years after diagnosis, with men who had received radical treatment(s).

Methods: The Prostate Cancer Care and Outcomes Study is a population‐based prospective cohort study in New South Wales, Australia. For this analysis we selected men with low risk localised disease who were aged less than 70 years at diagnosis. Validated instruments assessed health‐related quality‐of‐life and psychological outcomes relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression.

Results: Compared to patients who received one or more radical treatments in the 9–11 years after diagnosis (n = 305), men who remained on active surveillance (n = 36) had greater fear of cancer recurrence (AMD = 10.5; 95% CI [1.4, 19.7]), distress (AMD = 5.8; 95% CI [0.7, 10.8]), hyperarousal (AMD = 5.0; 95% CI [0.2, 9.7]) and cognitive avoidance (AMD = 7.9; 95% CI [1.5, 14.3]); but they also had better urinary incontinence scores (AMD = −11.8; 95% CI [−21.9, −1.7]), better sexual summary scores (AMD = −17.1; 95% CI [−30.8, −4.6]) and less sexual bother (AMD = −23.0; 95% CI [−43.4, −2.5]). Analysing patients according to their initial treatment, without regard to subsequent treatments, suggested that men who initially commenced active surveillance have similar long‐term psychological and quality‐of‐life outcomes as those who initially received radical treatment.

Conclusions: In this study of men diagnosed with low‐risk localised prostate cancer, analysing patients according to treatments received over the 9–11 years after diagnosis, rather than initial treatments received, suggested that the avoidance of active treatments provides long‐term benefits in terms of certain physical aspects of quality of life, but these benefits may come at a psychological cost.