Long-term Psychological and Quality-of-life Effects of Active Surveillance and Watchful Waiting After Diagnosis of Low-risk Localised Prostate Cancer

Eur Urol. 2018 Jun;73(6):859-867. doi: 10.1016/j.eururo.2017.08.013. Epub 2017 Aug 26.


Background: Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer.

Objective: To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancer patients.

Design, setting, and participants: The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancer patients aged <70 yr at diagnosis and participated in the 10-yr follow-up.

Outcome measurements and statistical analysis: Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression.

Results and limitations: At 9-11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD=5.9; 95% confidence interval or CI [0.5, 11.3] and AMD=5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD=5.3; 95% CI [0.2, 10.3] and AMD=7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD=-9.1; 95% CI [-16.3, -2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD=-16.8; 95% CI [-27.6, -6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation.

Conclusions: Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups.

Patient summary: This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes.

Keywords: Active surveillance; Distress; Localised; Low risk; Prostate cancer; Psychological; Quality of life; Sexual; Urinary; Watchful waiting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brachytherapy / adverse effects
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Prostatectomy / adverse effects
  • Prostatic Neoplasms / psychology*
  • Prostatic Neoplasms / therapy*
  • Quality of Life*
  • Radiotherapy Dosage
  • Risk Factors
  • Stress, Psychological / etiology
  • Surveys and Questionnaires
  • Time Factors
  • Urinary Incontinence / etiology
  • Urinary Incontinence / psychology
  • Watchful Waiting*