Mohan Ravinder, Beydoun Hind, Barnes-Ely Myra L, Lee LaShonda, Davis John W, Lance Raymond, Schellhammer Paul
Department of Family and Community Medicine, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA 23507, USA.
J Am Board Fam Med. 2009 May-Jun;22(3):247-56. doi: 10.3122/jabfm.2009.03.080200.
Cancer-specific mortality is projected to be only 1% in 15 years in approximately 75% of patients with screen-detected localized prostate cancer (LPC). Nearly 94% of patients choose treatment even though treatment damages health-related quality of life. No data are available regarding what survival benefit patients expected from treatment.
A self-administered mailed survey was sent to 184 men with newly diagnosed LPC to query patients about expected survival with treatment versus observation.
More than 90% of patients had at least a high school education and a ninth-grade health literacy. In addition, 68% patients had income of > or =$50,000. Mean cancer grade was 6.6. Twenty-three patients chose observation and 161 patients chose surgery or radiotherapy. Mean comorbidity adjusted life expectancy (CALE) without the cancer was 22.9 years. Without cancer treatment, 15.2% of patients expected to live <5 years, 48.8% 5 to 10 years, 33.5% 11 to 19 years, and 2.4% > or =20 years. With treatment, survival expectations were <5 years in 0.6%, 5 to 10 years in 6.5%, 11 to 19 years in 30.0%, and > or =20 years in 62.9% of patients. Age, prostate-specific antigen level, CALE, anxiety, depression, and social support were factors that predicted differences between CALE and patient survival expectations with and without treatment.
LPC patients grossly underestimated their life expectancy without treatment and grossly overestimated the survival benefit of treatment.
在约75%经筛查发现的局限性前列腺癌（LPC）患者中，预计15年后癌症特异性死亡率仅为1%。尽管治疗会损害健康相关生活质量，但近94%的患者仍选择接受治疗。目前尚无关于患者期望从治疗中获得何种生存获益的数据。
向184例新诊断为LPC的男性患者发送了一份自行填写的邮寄调查问卷，以询问患者对治疗与观察的预期生存情况。
超过90%的患者至少接受过高中教育且具备九年级的健康素养。此外，68%的患者收入≥50,000美元。平均癌症分级为6.6。23例患者选择观察，161例患者选择手术或放疗。无癌症情况下的平均合并症调整预期寿命（CALE）为22.9年。未经癌症治疗，15.2%的患者预计存活时间<5年，48.8%的患者预计存活5至10年，33.5%的患者预计存活11至19年，2.4%的患者预计存活≥20年。接受治疗后，0.6%的患者预期存活时间<5年，6.5%的患者预期存活5至10年，30.0%的患者预期存活11至19年，62.9%的患者预期存活≥20年。年龄、前列腺特异性抗原水平、CALE、焦虑、抑郁和社会支持是预测CALE与患者接受治疗和未接受治疗时生存预期差异的因素。
LPC患者严重低估了未经治疗时的预期寿命，且严重高估了治疗的生存获益。
