Overtreatment of localized prostate cancer is an important public health concern, since the survival benefits of surgery or radiation therapy have not been well established.
A 2016 study in the Annals of Family Medicine found that most men with localized prostate cancer underestimate their life expectancy without treatment and overestimate their potential gain in life expectancy with surgery or radiation. These misperceptions may lead to overtreatment, decisional regret, and decreased post-treatment quality of life.
To better understand the overtreatment of localized prostate cancer, researchers conducted a cross-sectional survey of 260 black and white men ages 75 or younger in the Detroit area who had newly diagnosed localized prostate cancer. The survey found that 33 percent of respondents expected to live fewer than five years if their cancer was left untreated, 41 percent said five to 10 years, 21 percent said 10 to 20 years, and 5 percent said more than 20 years.
With their chosen treatment (i.e., surgery, radiation or watchful waiting/active surveillance), 3 percent of patients expected to live less than five years, 9 percent said five to 10 years, 33 percent said 10 to 20 years, and 55 percent said more than 20 years. And although the largest and longest-followed active surveillance cohort of men diagnosed with localized prostate cancer actually showed prostate cancer-specific survival rates at 10- and 15-year follow-up of 98 percent and 94 percent, respectively, only 25 percent of all patients in the study expected to live more than 10 years.
Unrealistic patient expectations are concerning because active treatment does not provide a survival advantage compared with men who choose active surveillance when these patients are carefully chosen, and active treatment can be associated with erectile dysfunction and urinary incontinence.
When making a decision, patients with localized prostate cancer should include their doctors in the process to make sure that their expectations and choices support realistic treatment goals.