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Prostate cancer patients underestimate life expectancy without treatment

Recent findings published in the Annals of Family Medicine showed that most patients with prostate cancer underestimated their life expectancy without treatment and overestimated their life expectancy with treatment.

“We found that all men, regardless of age, race, education, and comorbidity, held unrealistic survival expectations of active treatment,” Jinping Xu, MD, MS, in the department of family medicine and public health sciences at Wayne State University, and colleagues wrote. “This unrealistic expectation appears to be driven by perceived (but not actual) severity of their cancer after adjustment for patient age and general health.”

Fear of cancer progression is commonly cited as the reason for choosing surgery or radiation over surveillance in the management of prostate cancer, the researchers wrote. However, a recent study showed that surgery did not reduce all-cause or prostate cancer–specific mortality when compared with surveillance. Overall, studies have yet to show that surgery and radiation are better options than surveillance.

To assess survival expectations of patients with localized prostate cancer (LPC), the researchers administered a survey to 260 men with newly diagnosed LPC aged younger than 76 years. The survey asked how long the patient expected to live with their chosen treatment — surgery, radiation, or surveillance — and how long they expected to live without treatment. In addition, the survey assessed factors related to their perceived life expectancy.

The researchers found that the difference in average perceived life expectancy between treatment and non-treatment was the greatest for radiation (11.94 years), then surgery (11.65 years), and then surveillance (7.87 years), despite the fact that radiation and surgery have yet to demonstrate longer life expectancies than surveillance. Age, treatment chosen, general health perception and perceived cancer seriousness were all predictive of perceived life expectancy, whereas race and actual tumor risk were not.

Studies have shown that between 86% and 98% of men with LPC do not die from their cancer in all age groups, the researchers wrote. In fact, more than 95% of patients with LPC live at least 10 years after their diagnosis, whereas only 25% of patients in this study expected to live more than 10 years. Further, surgery and radiation are associated with high rates of impotence and incontinence.

“There is an urgent need for interdisciplinary and cross-specialty communication with patients who have prostate cancer,” Xu and colleagues wrote. “Given the challenges in prognostication, primary care physicians should increase their own comfort with this type of counseling and their capacity to guide patients on this complex and often intimidating journey.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.