Patients' Survival Expectations before Localized Prostate Cancer Treatment by Treatment Status

Background: Cancer-specific mortality is projected to be only 1% in 15 years in approximately 75% of patients with screen-detected localized prostate cancer (LPC). Nearly 94% of patients choose treatment even though treatment damages health-related quality of life. No data are available regarding what survival benefit patients expected from treatment. Objectives: A self-administered mailed survey was sent to 184 men with newly diagnosed LPC to query patients about expected survival with treatment versus observation. Results: More than 90% of patients had at least a high school education and a ninth-grade health literacy. In addition, 68% patients had income of >=$50,000. Mean cancer grade was 6.6. Twenty-three patients chose observation and 161 patients chose surgery or radiotherapy. Mean comorbidity adjusted life expectancy (CALE) without the cancer was 22.9 years. Without cancer treatment, 15.2% of patients expected to live < 5 years, 48.8% 5 to 10 years, 33.5% 11 to 19 years, and 2.4% >= 20 years. With treatment, survival expectations were < 5 years in 0.6%, 5 to 10 years in 6.5%, 11 to 19 years in 30.0%, and >= 20 years in 62.9% of patients. Age, prostate-specific antigen level, CALE, anxiety, depression, and social support were factors that predicted differences between CALE and patient survival expectations with and without treatment. Conclusion: LPC patients grossly underestimated their life expectancy without treatment and grossly overestimated the survival benefit of treatment. (J Am Board Fam Med 2009;22:247-56.)