Factors influencing men undertaking active surveillance for the management of low-risk prostate cancer

Abstract

Purpose/Objectives: To identify and describe decision-making influences on men who decide to manage their low-risk prostate cancer with active surveillance. Research Approach: Qualitative, semistructured interview. Setting: The Prostate Centre at Vancouver General Hospital in Canada. Participants: 25 patients diagnosed with low-risk prostate cancer and on active surveillance. Methodologic Approach: An interpretative, descriptive, qualitative design. Main Research Variables: Factors that influenced men's decisions to take up active surveillance. Findings: The specialists' description of the prostate cancer was the most influential factor on men choosing active surveillance. Patients did not consider their prostate cancer to be life threatening and, in general, were relieved that no treatment was required. Avoiding treatment-related suffering and physical dysfunction and side effects such as impotence and incontinence was cited as the major reason to delay treatment. Few men actively sought treatment or healthpromotion information following their treatment decision. Female partners played a supportive role in the decision. The need for active treatment if the cancer progressed was acknowledged. Patients were hopeful that new treatments would be available when and if they needed them. Being older and having comorbidities did not preclude the desire for future active treatment. Patients carried on with their lives as usual and did not report having any major distress related to being on active surveillance. Conclusions: The study findings indicate that men are strongly influenced by the treating specialist in taking up active surveillance and planning future active treatments. As such, most men relied on their specialists' recommendation and did not perceive the need for any adjunct therapy or support until the cancer required active treatment. Interpretation: Oncology nurses should work collaboratively with specialists to ensure that men receive the information they need to make informed treatment decisions.