Living with untreated prostate cancer

Abstract

To summarize the literature on the predictors of quality of life (QoL) of patients with prostate cancer (PCa) on active surveillance and to highlight both risk factors of poor QoL and resilience factors that facilitate decision-making and promote adherence to active surveillance. Four main clusters of predicting variables have been highlighted: decision-making-related issues (patient's perception of the influence of physicians on the choice of active surveillance was related to higher decisional conflict; smaller amount of time to make a decision was predictive of poor QoL); demographic variable (such as marital status, age, and education level); psychological individual and interpersonal characteristics (neuroticism and impaired mental health were found to be associated with poor QoL, whereas positive outlook toward cancer was predictive of considering active surveillance as an effective management option for PCa); and patients' perceptions of cancer characteristics (prostate-specific antigen and number of positive cores). Men who choose active surveillance may present unique care needs. Identification of the most relevant risk factors for poor QoL can be useful to physicians who aim to target the psychosocial issues that patients and their families may need to address promptly. Predictive models could be used to identify active surveillance patients who present features of psychosocial vulnerability and to develop tailored psychoeducational interventions.