Patients' Survival Expectations With and Without Their Chosen Treatment for Prostate Cancer

Area of Science:

• Oncology
• Public Health
• Decision Science

Background:

• Overtreatment of screen-detected localized prostate cancer (LPC) is a significant public health issue.
• The survival benefit of aggressive treatments like surgery or radiation for LPC is not well-established.

Purpose of the Study:

• To investigate the survival expectations of patients diagnosed with localized prostate cancer (LPC).
• To compare survival expectations with and without chosen treatment modalities.

Main Methods:

• A population-based survey of 260 men (≤75 years) with newly diagnosed LPC was conducted.
• Multivariable analysis assessed perceived life expectancy with and without treatment, and associated factors.
• Factors analyzed included chosen treatment, age, general health, perceived cancer seriousness, race, and tumor risk.

Main Results:

• Without treatment, 33% expected <5 years, 41% 5-10 years. With treatment, only 3% expected <5 years, 9% 5-10 years.
• Treatment choice, age, health perception, and cancer seriousness predicted life expectancy differences.
• Men choosing surgery/radiation expected greater survival gains than those choosing watchful waiting/active surveillance.

Conclusions:

• Patients frequently underestimate life expectancy without treatment and overestimate gains from aggressive treatments.
• Unrealistic expectations can impair informed decision-making and contribute to LPC overtreatment.
• Primary care physicians should guide patients toward realistic expectations aligned with treatment goals.