title: Treatment Preferences for Active Surveillance versus Active Treatment among Men with Low-Risk Prostate Cancer.
abstract: Due to the concerns about the overtreatment of low-risk prostate cancer, active surveillance (AS) is now a recommended alternative to the active treatments (AT) of surgery and radiotherapy. However, AS is not widely utilized, partially due to psychological and decision-making factors associated with treatment preferences.
  
  
  
  In a longitudinal cohort study, we conducted pretreatment telephone interviews (N = 1,140, 69.3% participation) with newly diagnosed, low-risk prostate cancer patients (PSA ≤ 10, Gleason ≤ 6) from Kaiser Permanente Northern California. We assessed psychological and decision-making variables, and treatment preference [AS, AT, and No Preference (NP)].
  
  
  
  Men were 61.5 (SD, 7.3) years old, 24 days (median) after diagnosis, and 81.1% white. Treatment preferences were: 39.3% AS, 30.9% AT, and 29.7% NP. Multinomial logistic regression revealed that men preferring AS (vs. AT) were older (OR, 1.64; CI, 1.07-2.51), more educated (OR, 2.05; CI, 1.12-3.74), had greater prostate cancer knowledge (OR, 1.77; CI, 1.43-2.18) and greater awareness of having low-risk cancer (OR, 3.97; CI, 1.96-8.06), but also were less certain about their treatment preference (OR, 0.57; CI, 0.41-0.8), had greater prostate cancer anxiety (OR, 1.22; CI, 1.003-1.48), and preferred a shared treatment decision (OR, 2.34; CI, 1.37-3.99). Similarly, men preferring NP (vs. AT) were less certain about treatment preference, preferred a shared decision, and had greater knowledge.
  
  
  
  Although a substantial proportion of men preferred AS, this was associated with anxiety and uncertainty, suggesting that this may be a difficult choice.
  
  
  
  Increasing the appropriate use of AS for low-risk prostate cancer will require additional reassurance and information, and reaching men almost immediately after diagnosis while the decision-making is ongoing. Cancer Epidemiol Biomarkers Prev; 25(8); 1240-50. ©2016 AACR.
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. taylorkl@georgetown.edu.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Taylor
authors.affiliation: Division of General Internal Medicine, University of Iowa Carver College of Medicine/Iowa City VA Medical Center, Iowa.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Davis
authors.affiliation: Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: George
authors.initials: G
authors.lastname: Luta
authors.affiliation: Division of Research, Kaiser Permanente Northern California.
authors.forename: Amethyst
authors.initials: A
authors.lastname: Leimpeter
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: Tania
authors.initials: T
authors.lastname: Lobo
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Kelly
authors.affiliation: Division of Research, Kaiser Permanente Northern California.
authors.forename: Jun
authors.initials: J
authors.lastname: Shan
authors.affiliation: Department of Urology, Kaiser Permanente East Bay, Oakland, California.
authors.forename: David
authors.initials: D
authors.lastname: Aaronson
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Tomko
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Starosta
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Hagerman
authors.affiliation: Division of Research, Kaiser Permanente Northern California.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
mesh_terms: D000368:Aged; D001007:Anxiety; D003657:Decision Making; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy*; D012306:Risk; D011795:Surveys and Questionnaires; D057832:Watchful Waiting