Volk Robert J, McFall Stephanie L, Cantor Scott B, Byrd Theresa L, Le Yen-Chi L, Kuban Deborah A, Mullen Patricia Dolan
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Psychooncology. 2014 Apr;23(4):467-72. doi: 10.1002/pon.3444. Epub 2013 Nov 14.
Growing recognition that active surveillance (AS) is a reasonable management option for many men diagnosed with localized prostate cancer led us to describe patients' conceptualizations of AS and reasons for their treatment decisions.
Men were patients of a multidisciplinary prostate cancer clinic at a large tertiary cancer center where patients are routinely briefed on treatment options, including AS. We conducted a thematic analysis of interviews with 15 men who had chosen AS and 15 men who received radiation or surgery.
Men who chose AS described it as an organized process with a rigorous and reassuring protocol of periodic testing, with potential for subsequent and timely decision-making about treatment. AS was seen as prolonging their current good health and function with treatment still possible later. Rationales for choosing AS included trusting their physician's monitoring, 'buying time' without experiencing adverse effects of treatment, waiting for better treatments, and seeing their cancer as very low risk. Men recognized the need to justify their choice to others because it seemed contrary to the impulse to immediately treat cancer. Descriptions of AS by men who chose surgery or radiation were less specific about the testing regimen. Getting rid of the cancer and having a cure were paramount for them.
Men fully informed of their treatment options for localized prostate cancer have a comprehensive understanding of the purpose of AS. Slowing the decision-making process may enhance the acceptability of AS.
越来越多的人认识到，主动监测（AS）对于许多被诊断为局限性前列腺癌的男性来说是一种合理的治疗选择，这促使我们描述患者对主动监测的概念以及他们做出治疗决策的原因。
研究对象为一家大型三级癌症中心多学科前列腺癌诊所的患者，该诊所会定期向患者介绍包括主动监测在内的各种治疗选择。我们对15名选择主动监测的男性患者和15名接受放疗或手术的男性患者进行了访谈，并进行了主题分析。
选择主动监测的男性将其描述为一个有组织的过程，有严格且令人安心的定期检测方案，并且有可能随后及时做出治疗决策。主动监测被视为能延长他们目前的良好健康状态和功能，且之后仍有可能进行治疗。选择主动监测的理由包括信任医生的监测、“争取时间”而不经历治疗的不良反应、等待更好的治疗方法以及认为自己的癌症风险极低。男性患者意识到需要向他人解释自己的选择，因为这似乎与立即治疗癌症的冲动相悖。选择手术或放疗的男性对检测方案的描述则不那么具体。对他们来说，去除癌症并实现治愈至关重要。
充分了解局限性前列腺癌治疗选择的男性对主动监测的目的有全面的理解。放慢决策过程可能会提高主动监测的可接受性。
