Expectations of benefit in survival in patients choosing treatment for localized prostate cancer

Abstract

6549 Background: Three-fourths of screen-detected localized prostate cancer (LPC) has a Gleason score of <7. Untreated, such cancer has been projected to result in only 1% mortality over 15 years. However, despite serious risk of treatment side-effects, 94% of patients in the U.S. choose treatment for LPC. We surveyed, to our knowledge for the first time, how much longer survival patients expect by choosing treatment. Methods: 160 patients were studied before treatment for LPC. Their health-adjusted life expectancy (HALE) exceeded 10 years except for 2 patients. They were asked about their perceived reduction in survival (PRS) due to the cancer, and perceived benefit in survival (PBS) due to treatment for the cancer. Baseline HALE was calculated based on age and co-morbidities. Results: Mean age of patients was 61 years. Mean Gleason score of cancer was 6.5. Patients were mostly healthy, educated, and had higher than average health literacy and family incomes. 66% patients had HALE of >20 years; of them, over half believed they would live less than 10 years without treatment (PRS). Similarly, 106 patients expected to live over 20 years with treatment, but 45% of them believed they would live less than 10 years without treatment (PBS). PRS and PBS were higher in patients with higher HALE, cancer grade, anxiety, and depression, but were unrelated to race or scores of co-morbidities, functional capacity, generic health-related quality of life, social support, education, health literacy, family income, and satisfaction with life, health, and education given by physicians in treatment choices. Conclusions: Choice of treatment for LPC was associated with unrealistic pessimism regarding survival without treatment, and unrealistic optimism regarding benefit in survival due to treatment. No significant financial relationships to disclose.