title: Patients' Survival Expectations With and Without Their Chosen Treatment for Prostate Cancer.
abstract: Overtreatment of screen-detected localized prostate cancer (LPC) is an important public health concern, since the survival benefit of aggressive treatment (surgery or radiation) has not been well established. We investigated the survival expectations of patients who had LPC with and without their chosen treatment.
  
  
  
  A population-based sample of 260 men (132 black, 128 white) 75 years old or younger with newly diagnosed LPC completed a self-administered survey. How long the patients expected to live with their chosen treatment, how long they would expect to live with no treatment, and factors associated with the difference in perceived life expectancy were assessed using multivariable analysis.
  
  
  
  Without any treatment, 33% of patients expected that they would live less than 5 years, 41% 5 to 10 years, 21% 10 to 20 years, and 5% more than 20 years. With their chosen treatment, 3% of patients expected to live less than 5 years, 9% 5 to 10 years, 33% 10 to 20 years, and 55% more than 20 years. Treatment chosen, age, general health perception, and perceived cancer seriousness predicted the differences in perceived life expectancy, while race and actual tumor risk did not. After adjustment for other covariates, men who choose surgery or radiation expected greater gain in survival than men who chose watchful waiting or active surveillance.
  
  
  
  Most patients with LPC underestimated their life expectancy without treatment and overestimated the gain in life expectancy with surgery or radiation. These unrealistic expectations may compromise patients' ability to make informed treatment decisions and may contribute to overtreatment of LPC. Primary care physicians, when included in the decision process, should focus on helping patients develop realistic expectations and choices that support their treatment goals.
authors.affiliation: Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan jxu@med.wayne.edu.
authors.forename: Jinping
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan.
authors.forename: James
authors.initials: J
authors.lastname: Janisse
authors.affiliation: Department of Oncology, Wayne State University, Detroit, Michigan.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Ruterbusch
authors.affiliation: Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan.
authors.forename: Joel
authors.initials: J
authors.lastname: Ager
authors.affiliation: Department of Anesthesiology, Wayne State University, Detroit, Michigan.
authors.forename: Joe
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
authors.affiliation: Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan.
authors.forename: Kendra L
authors.initials: KL
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D006801:Humans; D008017:Life Expectancy; D016014:Linear Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011859:Radiography; D013514:Surgical Procedures, Operative
keywords: active surveillance; localized prostate cancer; radiation; shared decision making; surgery; survival expectation; watchful waiting