The psychology of active surveillance: learning to live with an untreated cancer.

Abstract

In recent years there has been emerging interest in alternative management strategies designed to reduce the morbidity of treatment for low risk localised prostate cancer. Active surveillance (AS) protocols for the close observation and management of men with low risk localised prostate cancer have emerged in the clinical and research literature as a viable and safe option in managing these men, potentially avoiding, or at least delaying, radical treatment. However, the decision to actively monitor, rather than actively treat cancer can be challenging for patients, as it contradicts commonly held beliefs that cancer requires immediate and radical treatment, and there is growing awareness that AS could be associated with heightened levels of patient anxiety. Qualitative research has identified that men do experience uncertainty, worry and fear about cancer progression, PSA and biopsy testing. Furthermore, there have been some studies that have reported that anxiety may be a contributing factor in patient choice to cease AS and engage in active radical treatment for their prostate cancer. It has been reported that as many as 45% of men opt for active radical treatment without experiencing clinical signs of disease progression or other clinical indication to do so. With this comes the need for a significant change in patient expectations and understanding of low risk localised prostate cancer and there are important psychological considerations that need to be made when counselling men to consider AS as a management approach to their prostate cancer.