Living “without treatment”: how men respond to active surveillance


Better understanding of how different men respond to the uncertainty and quality of life issues associated with active surveillance as a method to manage low- and intermediate-risk prostate cancer has the potential to enhance the delivery of care for such patients.

Hegarty et al. set out to enhance our understanding of the experience of active surveillance for prostate cancer among a small number of Irish and American patients of > 65 years of age by assessing their quality of life and levels of uncertainty during their management.

A total of 29 men completed quantitative, descriptive questionnaires, producing the following results:

  • Men undergoing active surveillance in the United States have slightly higher levels of uncertainty than those in Ireland.
  • Primary appraisal, opportunity, and danger appraisal were consistent between samples from both countries.
  • Overall, quality-of-life scores were similar among active surveillance participants in both countries, but subscale scores identified both similarities and differences.
    • Irish men had lower mean role and social function scores than Americans.
    • Irish men reported higher general health and energy levels.
    • Irish men reported more urine bother and less sexual bother than Americans.

It is clear that there are societal and cultural differences in response to the stress of living with prostate cancer on an active surveillance regimen. The authors conclude that “health care professionals must develop an awareness of how prostate cancer affects the man’s physical and psychological health care outcomes” in order to manage patients efferctively on active surveillance.

The “New” Prostate Cancer InfoLink believes that it will be important to build such quality of life assessments into large trials of thesafety and effectiveness of active surveillance (if this has not already been done).

2 Responses

  1. I have heard it said that American men are more risk-averse than others and that is one reason they are less likely to choose AS. Somehow this characterization doesn’t sit right with me. Americans take risks in business — but maybe not with their health.

    Do you have any Celtic blood in you that might explain the differences between the Irish and Americans? :-)

  2. So Leah. My mother is 100% Irish going back 4 generations … but how much of that is actually Celtic is a very different question.

    Between the multiple invasions of Ireland by the Normans, the Norse, the Saxons, the English (several times), the Hugenots, Cromwell, etc., if you you haven’t got a 600+ year genealogy that documents your Celticness — which is probably unlikely outside the far west of Ireland (Connemara, the Dingle Peninsula, parts of Kerry) — one would be hard-pressed today to claim actual Celtic blood!

    And of course now I’ve upset everyone whose ancestors came from Ireland to America during the potato famines!

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