Living with Localized Prostate Cancer - Decision-Making and Coping with the Illness

Abstract

Men diagnosed with localized prostate cancer must make a choice between treatment strategies that differ considerably in their side effects and have different long-term requirements for coping with the disease. The aim of this study was to describe how men perceive their treatment decision retrospectively and which coping strategies they use. Fifteen men (age mean=67.13±9.38 years) diagnosed with localized prostate cancer participated in three focus groups, grouped according to the treatment strategies radical prostatectomy, radiotherapy, and active surveillance. An interview guide structured the focus group discussions. In analogy to the structured interview, the material was deductively sorted in a first step; in a second step, sub-categories were developed inductively from the material. The content analysis revealed four particularly relevant topics: (1) The communication of the diagnosis and the associated reactions. (2) The decision-making process and the perceived time pressure. (3) The coping strategies, which showed a broad spectrum ranging from distraction and information search to lifestyle changes. (4) The perception of the disease over time. In particular men under active surveillance highlighted the importance of deceleration in their decision making and the role of lifestyle changes. The time of the diagnosis is still very much present even a long time after the diagnosis has been communicated. It is possible that a decrease in time pressure and deceleration would lead to more men deciding in favor of an observational strategy. Lifestyle changes could especially help men who choose active surveillance to overcome the feeling of "doing nothing" and gain a sense of control. In view of the variety of possible treatment strategies, an ethic of action is required that meets the need for an individual and preference-sensitive decision.