Decision-making Processes among Prostate Cancer Survivors with Rising PSA Levels: Results from a Qualitative Analysis.
Prostate cancer survivors with a rising prostate-specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease they thought they had conquered. Guided by self-regulation theory, the present study examined the cognitive and affective processes involved in shared decision making between physicians and patients who experience a rising PSA after definitive treatment for prostate cancer.



In-depth interviews were conducted with 34 prostate cancer survivors who had been diagnosed with a rising PSA (i.e., biochemical failure) within the past 12 months. Survivors were asked about their experiences and affective responses after being diagnosed with a rising PSA and while weighing potential treatment options. In addition, patients were asked about their decision-making process for the initial prostate cancer treatment.



Compared with the initial diagnosis, survivors with a rising PSA reported increased negative affect following their diagnosis, concern about the treatability of their disease, increased planning and health behavior change, heightened levels of worry preceding doctor appointments (especially prior to the discussion of PSA testing results), and a strong reliance on physicians' treatment recommendations.



Prostate cancer survivors' decision-making processes for the treatment of a rising PSA are markedly different from those of the initial diagnosis of prostate cancer. Because patients experience heightened distress and rely more heavily on their physicians' recommendations with a rising PSA, interactions with the health care provider provide an excellent opportunity to address and assist patients with managing the uncertainty and distress inherent with rising PSA levels.
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY (MJS, CJN)
Megan Johnson
MJ
Shen
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY (MJS, CJN)
Christian J
CJ
Nelson
Department of Psychology, Ohio State University, Columbus, OH (EP)
Ellen
E
Peters
Department of Medicine; Memorial Sloan-Kettering Cancer Center, New York, NY (SFS)
Susan F
SF
Slovin
Department of Urology, Mount Sinai, New York, NY (SJH, MH, PCH, MAD)
Simon J
SJ
Hall
Department of Urology, Mount Sinai, New York, NY (SJH, MH, PCH, MAD)
Matt
M
Hall
Department of Urology, Mount Sinai, New York, NY (SJH, MH, PCH, MAD)
Phapichaya Chaoprang
PC
Herrera
Department of Medicine, Robert Wood Johnson Medical School, Rutgers, New Brunswick, NJ (EAL, HL).
Elaine A
EA
Leventhal
Department of Medicine, Robert Wood Johnson Medical School, Rutgers, New Brunswick, NJ (EAL, HL).
Howard
H
Leventhal
Department of Urology, Mount Sinai, New York, NY (SJH, MH, PCH, MAD)
Michael A
MA
Diefenbach
D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003657:Decision Making; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D010817:Physician-Patient Relations; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D036301:Qualitative Research; D017741:Survivors / Q000523:psychology*
D017430:Prostate-Specific Antigen
androgen deprivation therapy; decision making; prostate cancer; rising prostate specific antigen; survivorship