Lack of Knowledge Prevents Men with Early-Stage Prostate Cancer from Choosing Active Surveillance

August 2013 Vol 6, No 6 Special Issue - Prostate Cancer
Wayne Kuznar

Chicago, IL—A lack of awareness of active surveillance prevents more men with early-stage prostate cancer from choosing this option, according to a study funded by the Centers for Disease Control and Prevention (CDC), which showed that African-American men are more influenced by convenience than Caucasian men in their choice of treatment. Spouses and significant others are also influential in the decision, and they tend to be less enthusiastic about active surveillance than the men who have prostate cancer.

The study was presented in a poster session by Theresa W. Gillespie, PhD, MA, Associate Professor, Departments of Surgery and of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA.

The CDC estimates that approximately 50% of men diagnosed with prostate cancer remain asymptomatic and do not require treatment; yet, approximately 90% of these men receive surgery or radiation. African-American men have been reported to receive aggressive therapy significantly less often than Caucasians, although prostate tumors in African-American men are often at higher risk for poor outcomes, raising questions about health disparities in treatment selection.

“The CDC was particularly interested in knowing why people don’t choose active surveillance more, and what might be some of the differential predictors or variables that could lead to more informed decision-making about active surveillance,” said Dr Gillespie.

Of the 214 men and 188 significant others who participated in the 5-center study, 63% were African American. All participants completed quantitative questionnaires before attending focus group sessions. There were 27 focus groups for the men and 27 for their significant others.

A total of 57.6% of African-American men reported that convenience influenced their treatment choice compared with 30.8% of Caucasian men (P = .004). After adjusting for education, comorbidities, insurance, age, health literacy, distance to treatment center, willingness to travel, income, and numeracy score, African-American men were nearly 3 times more likely to be influenced by convenience (odds ratio, 2.84) than Caucasians. Rural residence, however, did not affect decision-making.

“Convenience might mean that men would not choose surgery because of the after effects; they would be inconvenienced if they are incontinent, for example,” said Dr Gillespie. Significant others tend to value treatment efficacy more than side effects.

Lack of awareness of active surveillance as a treatment option and no designated provider to present active surveillance as a viable choice were identified as key reasons for not choosing it.

The focus groups showed that physician treatment discussions tend to be limited to the physicians’ specialty. “The urologist didn’t talk about it because he’s usually talking about surgery. Radiation oncologists don’t talk about it because they usually talk about external beam [radiation therapy] or brachytherapy,” she said. “No one has skin in the game in terms of active surveillance.”

Patients and spouses also wanted feedback from patients who had been through the various treatments, Dr Gillespie said.

“Somewhere in the discussion, active surveillance has to be mentioned,” she said. “There may be a real opportunity to take the time for a comprehensive discussion of treatment options, because in early-stage prostate cancer, you don’t have to choose what you’re going to do immediately.”

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Last modified: August 22, 2013
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