title: Patients' perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy.
abstract: Treatment choice for localized prostate cancer (PCa) is a controversial issue, and mortality risk is probably the most decisive factor in this regard. The study aimed to compare prostate-cancer-specific mortality risk estimates for different treatment options assigned by patients managed with active surveillance (AS), radical prostatectomy (RP) and patients who had discontinued AS (DAS). Patients initially managed with AS or RP (N = 370) were matched according to length of therapy. All patients completed mailed questionnaires assessing their mortality risk estimates (in %) and prostate-cancer-specific anxiety. Differences in risk estimates among the three treatment groups were analyzed using ANOVA, relationships of clinical and psychosocial variables with risk estimates using standard multiple regression. In all treatment groups, the prostate- cancer-specific mortality risk was overestimated. This applied whether it was the patient's own treatment or the alternative treatment option. RP patients assigned a mortality risk to AS that was almost three times higher than that assigned to RP (50.9 ± 25.0 vs. 17.8 ± 19.7, d = 1.48; p < 0.001). Anxiety was significantly associated with risk estimates for AS (p = 0.008) and RP (p = 0.001). Compared with clinical data that suggest that the prostate-cancer-specific mortality risk for AS is low and does not significantly differ from that for RP, patients strongly overestimated the mortality risk. This was most markedly so in RP patients, who drastically overestimated the benefits of RP compared to the risk of AS. This overestimation could increase overtreatment and should therefore be corrected by better patient education.
authors.affiliation: Institute of Medical Psychology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Kendel
authors.affiliation: Institute of Medical Psychology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Helbig
authors.affiliation: Institute of Medical Biometrics and Clinical Epidemiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Neumann
authors.affiliation: Department of Urology, University of Cologne, Köln, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Herden
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin and Berlin Institute for Urologic Research, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Stephan
authors.affiliation: Department of Urology, HELIOS Clinic Berlin-Buch, Berlin, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Schrader
authors.affiliation: Department of Social Psychology and Decision Sciences, University of Konstanz, Konstanz, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gaissmaier
mesh_terms: D000368:Aged; D001007:Anxiety; D005239:Fear; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010465:Perception; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D012307:Risk Factors; D057832:Watchful Waiting
keywords: active surveillance; anxiety; localized prostate cancer; mortality risk estimates; radical prostatectomy