Patients overestimate mortality risk of Active Surveillance

Around 67,000 men in Germany are confronted with the diagnosis of prostate cancer every year. Thanks to significantly improved early detection possibilities, especially since the introduction of the PSA test, more than 90 percent of all tumours are now detected at an early and therefore mostly curable stage. If the tumour is limited to the prostate, the patient has several options for therapy: Internal radiation (brachytherapy), external radiation or radical surgery. In men with low-risk carcinoma, it is even possible to monitor the tumour closely (Active Surveillance, AS)

If a man is diagnosed with prostate cancer, the fear of dying from the disease plays an important role in the choice of therapy,"says PD Dr. Friederike Kendel from the Institute of Medical Psychology at the Charité. The patient will wonder how the risk of dying from the disease can be reduced by choosing a certain treatment,"says the psychologist. Knowledge of the so-called mortality risk is therefore very important for a well informed patient decision. 

In order to investigate how patients perceive the mortality risk figures of the individual treatment options, the Charité workgroup around Friederike Kendel conducted a study1 with a total of 292 patients. They were asked one to five years after the diagnosis of a localized prostate carcinoma, how they assessed the risk of dying from this disease and not from another cause. The study participants were either under active observation (AS) or undergoing radical prostatectomy (RP).

Risk of mortality is greatly overestimated

The study impressively demonstrated that the risk of mortality is significantly overestimated regardless of the treatment option (surgery or wait-and-see). For example, the self-assessed risk of 20 to 50 percent was significantly higher than the actual risk of an average of 0.1 to 3 percent2/3."It was particularly striking, however, that men who opted for surgical removal of the prostate gland particularly appreciated the mortality risk of active surveillance," explained Dr. Kendel. While men who were under active observation thought that about 25 percent of men under AS would die from prostate cancer, men who had undergone prostatectomy reported an average of 51 percent.

Information on the various treatment options and their morbidity risk should therefore be presented and communicated to the patient as transparently as possible,"emphasizes Dr. Kendel. Above all, it is important to take away from these men the fear of dying from localised prostate cancer. This is because there are still completely wrong ideas that put the prostate carcinoma on a par with a death sentence, regardless of the stage and aggressiveness of the tumor. The mediation of realistic assessments not only requires a high degree of empathy from the treating physician, but is also associated with a high expenditure of time. But it is only when the figures are correctly understood that an informed decision can be made,"said the Berlin psychologist.

Literature:

  1. Kendel F, Helbig L, Neumann K, Herden J, Stephan C, Schrader M, Gaissmaier W. Patients' per-ceptions of mortality risk for localized prostate cancer vary markedly depending on their treat-ment strategy. International Journal of Cancer. 2016;139(4):749-53.
  2. Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 2015;33:272-7.
  3. Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ, Carter HB: Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer J Clin Oncol. 2015;33:3379-85.

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