Patients' survival expectations before localized prostate cancer treatment by treatment status

J Am Board Fam Med. May-Jun 2009;22(3):247-56. doi: 10.3122/jabfm.2009.03.080200.

Abstract

Background: Cancer-specific mortality is projected to be only 1% in 15 years in approximately 75% of patients with screen-detected localized prostate cancer (LPC). Nearly 94% of patients choose treatment even though treatment damages health-related quality of life. No data are available regarding what survival benefit patients expected from treatment.

Objectives: A self-administered mailed survey was sent to 184 men with newly diagnosed LPC to query patients about expected survival with treatment versus observation.

Results: More than 90% of patients had at least a high school education and a ninth-grade health literacy. In addition, 68% patients had income of > or =$50,000. Mean cancer grade was 6.6. Twenty-three patients chose observation and 161 patients chose surgery or radiotherapy. Mean comorbidity adjusted life expectancy (CALE) without the cancer was 22.9 years. Without cancer treatment, 15.2% of patients expected to live <5 years, 48.8% 5 to 10 years, 33.5% 11 to 19 years, and 2.4% > or =20 years. With treatment, survival expectations were <5 years in 0.6%, 5 to 10 years in 6.5%, 11 to 19 years in 30.0%, and > or =20 years in 62.9% of patients. Age, prostate-specific antigen level, CALE, anxiety, depression, and social support were factors that predicted differences between CALE and patient survival expectations with and without treatment.

Conclusion: LPC patients grossly underestimated their life expectancy without treatment and grossly overestimated the survival benefit of treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Anxiety / epidemiology
  • Attitude to Health*
  • Comorbidity
  • Depression / epidemiology
  • Educational Status
  • Health Surveys
  • Humans
  • Life Expectancy*
  • Male
  • Middle Aged
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / mortality*
  • Prostatic Neoplasms / therapy*
  • Social Support
  • Socioeconomic Factors
  • Survival Rate

Substances

  • Prostate-Specific Antigen