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Authors Bellardita L, Valdagni R, van den Bergh R, et al.
Review Date December 2014
Citation European Urology 2014 (in press): http://dx.doi.org/10.1016/j.eururo.2014.10.028
One of the main risks associated with PSA testing for prostate cancer is the potential for over-diagnosis and over-treatment with subsequent treatment-associated morbidity. To avoid or delay radical treatment in men diagnosed with low risk prostate cancer, active surveillance (AS) is becoming a more popular option. However, there is concern amongst health professionals and men that living with cancer without active treatment may have negative psychological and quality of life effects. Understanding the extent of these effects can help to guide clinical practice and advice for men with low risk prostate cancer.
In response to as call for more evidence on quality of life (QoL) in men undergoing AS at an international AS conference, the authors conducted a systematic review.
Embase, Medline, Psychinfo, Cochrane Central, Web of Science, and PubMed databases were searched in May 2014 using the search terms quality of life, active surveillance, prostate cancer and their synonyms. Reference lists and previous literature reviews were also searched. The psychological dimensions related to health-related QoL (HRQoL) outcomes were anxiety and depression, distress, decisional conflict, and mental health. Two authors independently screened all the titles and abstracts and the resulting reference list was compiled by a third author for full text screening and data extraction. Three authors conducted data extraction.
The literature search identified 1157 unique citations; 1087 were excluded as they were not original research studies, or participants were on watchful waiting rather than AS; 73 full texts were screened and 63 excluded.
Only ten clinical and research-based AS studies worldwide were identified that measured HRQoL and related psychological measures: six cross-sectional studies and four cohort studies (9 to 36 months follow-up), published between 2006 and 2014. In total, 966 men undergoing AS were assessed (mean age: 66 years). Fifteen different outcome measures were used, including SF-36, SF-12, cancer QoL scales and the Hospital Anxiety and Depression (HADS) scale. AS patients had good overall HRQoL scores, which were comparable or better than those of comparator groups: patients undergoing post-radical treatment (4 studies), men’s partners (1 study) and population-based data (3 studies). Anxiety and depression scores were generally low and did not increase over time in cohort studies. None of the studies were randomized with selection bias likely to be an issue. Decreased psychological well-being appeared to be associated with AS patients’ baseline and clinical characteristics.
The available studies suggest that AS does not generally cause psychological distress or reduced QoL. However, longer term, randomized studies are required to adequately assess the impact on QoL of AS in men with low risk prostate cancer.
Points to Note
- This systematic review of studies on quality of life and psychological impact of AS in men with low risk prostate cancer suggests AS may be a good option for many men with screen-detected cancers.
- The number of studies identified was small and the 4 cohort studies had short follow-up; more data is required to fully understand the impact of AS.
- Only quantitative studies were included even though there are some qualitative studies available that may provide helpful insights.
- No meta-analysis could be conducted due to differing study designs and outcomes measures.
- Selection bias is likely to be playing a part as none of the studies were randomised.
- The ProtecT RCT will report 10-year data in 2016 and is likely to provide good information on clinical outcomes and medium and long-term effects of AS on men’s well-being.