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Confidence and Uncertainty Long After Initial Treatment for Early Prostate Cancer: Survivors' Views of Cancer Control and the Treatment Decisions They Made

Jack A. Clark, James A. Talcott

From the Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Boston University School of Public Health; Center for Outcomes Research, MGH Cancer Center, Massachusetts General Hospital; and Harvard Medical School, Boston, MA

Address reprint requests to Jack A. Clark, PhD, Department of Health Services, Boston University School of Public Health, 715 Albany St, T3-W, Boston, MA 02118; e-mail: jaclark{at}bu.edu

PURPOSE: The many years most men diagnosed with early prostate cancer live after diagnosis allow evolving assessments of their cancer control and their treatment choices, but little is known of these outcomes or the factors that influence them.

PATIENTS AND METHODS: We surveyed an established, prospective cohort that had initiated treatment for early prostate cancer 4 to 8 years previously. We assessed perceived cancer control, quality of treatment decisions, and other domains of quality of life, along with treatment-related urinary, bowel, and sexual dysfunction.

RESULTS: Most men reported high confidence in cancer control and their treatment decisions, but many reported misgivings about one or both. The diagnostic, treatment, and quality-of-life factors associated with these two outcomes were distinct. Perceived cancer control was lower among those with adverse medical factors: higher pretreatment Gleason scores, subsequent rises in prostate-specific antigen (PSA), and secondary androgen ablation therapy. Confidence in treatment decisions was unrelated to these factors and was higher in men who opted for radical prostatectomy or brachytherapy, reported close attention to current PSA, had high masculine self-esteem and little distress from sexual dysfunction, and were married.

CONCLUSION: Although perceptions of cancer control and the quality of their treatment decisions are linked, men can distinguish between these two outcomes. They incorporate objective indicators of high risk and adverse outcomes when assessing their cancer control; confidence in treatment decisions represents a more complex psychosocial adjustment to the persistent uncertainty that originates with their diagnosis.

Supported by Grant No. DAMD 17-01-1-0026 from the US Department of Defense.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.