The Influence of Psychosocial Constructs on the Adherence to Active Surveillance for Localized Prostate Cancer in a Prospective, Population-Based Cohort

Abstract Objective To evaluate the influence of psychosocial factors such as prostate cancer (PCa) anxiety, social support, participation in medical decision-making (PDM), and education level on patient decisions to discontinue PCa active surveillance (AS) in the absence of disease progression. Materials and Methods The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based cohort study of men with localized PCa diagnosed in 2011-2012. PCa anxiety, social support, participatory decision making (PDM), education level, and patient reasons for discontinuing AS were assessed through patient surveys. A Cox proportional hazards model examined the relationship between psychosocial variables and time to discontinuing AS. Results Of 531 AS patients, 165 (30.9%) underwent treatment after median follow-up of 37 months. Whereas 69% of patients cited only medical reasons for discontinuing AS, 31% cited at least one personal reason, and 8% cited personal reasons only. Patients with some college education discontinued AS significantly earlier (HR: 2.0, 95% CI: 1.2, 3.2) than patients with less education. PCa anxiety, social support, and PDM were not associated with seeking treatment. Conclusion We found that 31 percent of men who choose AS for PCa discontinue AS within 3 years. Eight percent of men who sought treatment did so in the absence of disease progression. Education, but not psychosocial factors, seems to influence seeking definitive treatment. Future research is needed to understand how factors unrelated to disease severity influence treatment decisions among AS patients in order to identify opportunities to improve adherence to AS.