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Abstract
Background
Prostate cancer is a frequently diagnosed cancer and made up 6% of male cancer deaths globally in 2008. Its incidence varies more than 25-fold worldwide, which is primarily attributed to the implementation of the prostate-specific antigen (PSA) test in developed countries. To reduce harm of overdiagnosis, most international guidelines recommend surveillance programmes. However, this approach can entail negative psychosocial consequences from being under surveillance for an (over)diagnosed prostate cancer.
Aim
To explore men’s feelings and experiences in a surveillance programme.
Design and setting
Qualitative study with Danish men diagnosed with asymptomatic prostate cancer Gleason score ≤ 6, who are in a surveillance programme
Methods
12 semi-structured, individual interviews were conducted and analysed with systematic text condensation and selected theories.
Results
Most informants reported that they were astonished at the time of diagnosis. They were aware of the small likelihood of dying from cancer, but in some cases, the uncertainty created ambivalence between knowing and not knowing. The men expressed their risk awareness in different ways: a realization that life does not last forever, uncertainty towards the future, a feeling of powerlessness, and a need for control.
Conclusions
The men in this study had substantial psychosocial consequences from being labelled with a cancer diagnosis. Bearing these men’s high risk of overdiagnosis in mind, it is important to discuss whether the harms of this diagnosis outweigh the benefits. The psychosocial consequences of being in a prostate cancer surveillance programme should be explored further.
Current awareness: The number of men living with an asymptomatic prostate cancer has increased the last 20 years after the implementation of the PSA test.
Main Statements:
Men living with an asymptomatic, low-risk prostate cancer experience negative psychocosial consequences
GPs should consider the possible negative psychosocial consequences in their decision-making of measuring the PSA level
KEY POINTS
Acknowledgements
We would like to thank the men who contributed to this article with their time and participation. We would also like to thank The Department of Urology, Zealand University Hospital for their help with recruiting patients.
Disclosure statement
The authors report no conflict of interest. The authors are solely responsible for the content and writing of this article. This study was funded with a scholarship from the Lundbeck Foundation with SBN as receiver.