Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America.
Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America.
PLoS One. 2019 Nov 20;14(11):e0225134. doi: 10.1371/journal.pone.0225134. eCollection 2019.
Active surveillance (AS) is an increasingly utilized strategy for monitoring men with low-risk prostate cancer (PCa) that allows them to defer active treatment (AT) in the absence of cancer progression. Studies have explored reasons for selecting AS and for then switching to AT, but less is known about men's experiences being on AS. We interviewed men to determine the clinical and psychological factors associated with selecting and adhering to AS protocols.
We conducted semi-structured interviews with men with a low-risk PCa at two academic medical centers. Subjects had either been on AS for ≥ 1 year or had opted for AT after a period of AS. We used an iterative, content-driven approach to analyze the interviews and to identify themes.
We enrolled 21 subjects, mean age 70.4 years, 3 racial/ethnic minorities, and 16 still on AS. Men recognized the favorable prognosis of their cancer (some had sought second opinions when initially offered AT), valued avoiding treatment complications, were reassured that close monitoring would identify progression early enough to be successfully treated, and trusted their urologists. Although men reported feeling anxious around the time of surveillance testing, those who switched to AT did so based only on evidence of cancer progression.
Our selected sample was comfortable being on AS because they understood and valued the rationale for this approach. However, this highlights the importance of ensuring that men newly diagnosed with a low-risk PCa are provided sufficient information about prognosis and treatment options to make informed decisions.
主动监测（AS）是一种越来越被用于监测低危前列腺癌（PCa）患者的策略，使他们能够在没有癌症进展的情况下推迟主动治疗（AT）。已经有研究探索了选择 AS 和转为 AT 的原因，但对于男性接受 AS 治疗的经历知之甚少。我们对男性进行了采访，以确定与选择和遵守 AS 方案相关的临床和心理因素。
我们在两家学术医疗中心对患有低危 PCa 的男性进行了半结构化访谈。受试者要么已经接受 AS 治疗≥1 年，要么在 AS 期间选择了 AT。我们使用迭代、内容驱动的方法分析访谈并确定主题。
我们共纳入 21 名受试者，平均年龄为 70.4 岁，包括 3 名少数族裔，16 名仍在接受 AS 治疗。男性认识到他们癌症的良好预后（有些人在最初被建议接受 AT 时曾寻求过第二意见），重视避免治疗并发症，对密切监测能及早发现进展并成功治疗感到放心，并且信任他们的泌尿科医生。尽管男性在接受监测检查时报告感到焦虑，但那些转为 AT 的人只是基于癌症进展的证据。
我们选择的样本对接受 AS 治疗感到满意，因为他们理解并重视这种方法的原理。然而，这突出了确保新诊断为低危 PCa 的男性获得关于预后和治疗选择的充分信息以做出明智决策的重要性。
