Active surveillance for prostate cancer is usually considered for low-risk patients. It is often used to monitor a patient’s cancer closely without administering treatment unless test results show that their condition is worsening. According to cancer.org, active surveillance typically includes a doctor visit with a prostate-specific antigen (PSA) blood test about every six months, along with a digital rectal exam (DRE) about once a year. Research suggests that up to 50% of patients on active surveillance for prostate cancer will discontinue their monitoring within five years. However, reasons for discontinuing have not been explored in-depth.
In an investigation by McIntosh M, Opozda MJ, O’Callaghan M, et al, prostate cancer patients who had been on active surveillance for at least six months were recruited and surveyed. A questionnaire was assigned to participants that assessed their reasons for receiving definitive treatment, and if their reasons were personal or medical. Some participants were further interviewed to explore their questionnaire responses, and clinical information was taken from a state-level population registry. The survey was completed by 103 participants, while 33 were also interviewed. Out of the full group, 52% of participants had discontinued their active surveillance for definitive treatment.
Some of the most common reasons given by patients for discontinuing active surveillance included disease progression, doctor recommendation, desire to act, and fear of progression. Other reasons that influenced their decision-making included clinical consistency, information, and lifestyle advice. Many of the participants who either received or considered treatment noted that they had weighed medical and personal factors equally in making their decision.
The interviewed participants noted that they strongly considered any amount of disease progression and that their reasons for discontinuation included personal factors, including fear of progression, family concerns, and adverse vicarious experiences when deciding whether to pursue further treatment.
In another study by Kinsella N, Beckmann K, Cahill D, et al, an educational seminar designed by both patients and clinicians about imaging, biopsy techniques, lifestyle advice, and more, were given to prostate cancer patients on active surveillance. After a single educational seminar was delivered to groups of patients with intermediate- or low-risk prostate cancer, the active surveillance dropout rate was lowered by 50%. Patients were shown to feel more supported when provided with educational intervention on active surveillance within three months of their treatment choice.
Both medical and personal factors serve as definitive considerations for prostate cancer patients when deciding whether they should discontinue their active surveillance or not. Identifying predictors of discontinuation early on is important for informing supportive care services in advance to improve patients’ active surveillance management.
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