title: How does active surveillance for prostate cancer affect quality of life? A systematic review.
abstract: BACKGROUND
  The optimal management of screen-detected, localised prostate cancer remains controversial, related to overtreatment issues of screening and the nonrandomised evidence base. Active surveillance (AS) aims to delay or avoid curative therapy but may potentially harm patients' well-being through living with untreated prostate cancer.
  
  
  OBJECTIVE
  To systematically review the literature on quality of life (QoL) in patients undergoing AS.
  
  
  METHODS
  Embase, Medline, Psychinfo, Cochrane Central, Web of Science, and PubMed databases were searched in May 2014 using quality of life, active surveillance, prostate cancer, their synonyms, and targeted manual searches. The psychological dimensions related to health-related QoL (HRQoL) outcomes were anxiety and depression, distress, decisional conflict, and mental health.
  
  
  RESULTS
  Ten clinical and research-based AS studies worldwide measured HRQoL and related psychological facets in six cross-sectional studies and four cohorts (follow-up: 9-36 mo; published: 2006-2014). Six studies were linked to published AS cohorts. In total, 966 men undergoing AS (mean: 102 per study) were assessed (mean age: 66 yr). AS patients had good overall HRQoL scores, which were comparable or better than those of patients undergoing postradical treatment (comparator group in four studies), men's partners (one study) and population-based data (three studies). Anxiety and depression scores were favourable. Selection bias may be present, as none were randomised comparisons. Decreased psychological well-being may be partly predicted by AS patients' baseline and clinical characteristics.
  
  
  CONCLUSIONS
  Patients undergoing AS reported good QoL and did not appear to suffer major negative psychological impacts. Longer follow-up is required as well as investigation into which patients are predisposed to negative impact and leaving AS prematurely.
  
  
  RESULTS
  We reviewed the published evidence for quality-of-life impact on men with prostate cancer being monitored by active surveillance. The men who were on active surveillance usually reported good levels of well-being and did not appear to suffer major negative psychological impacts. The research findings suggest little presence of anxiety and depression and high overall quality of life related to their disease. However, there are few long-term studies, so more high-quality research is needed to make definitive recommendations.
authors.affiliation: Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. Electronic address: lara.bellardita@istitutotumori.mi.it.
authors.forename: Lara
authors.initials: L
authors.lastname: Bellardita
authors.affiliation: Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Valdagni
authors.affiliation: Department of Urology, Utrecht University Medical Centre, Utrecht, The Netherlands.
authors.forename: Roderick
authors.initials: R
authors.lastname: van den Bergh
authors.affiliation: Europa Uomo.
authors.forename: Hans
authors.initials: H
authors.lastname: Randsdorp
authors.affiliation: Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Repetto
authors.affiliation: Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Lionne D F
authors.initials: LD
authors.lastname: Venderbos
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: J Athene
authors.initials: JA
authors.lastname: Lane
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ida J
authors.initials: IJ
authors.lastname: Korfage
mesh_terms: D006304:Health Status; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*
keywords: Active surveillance; Anxiety; Depression; Health-related quality of life; Prostate cancer; Systematic review; Well-being